International Handbook on Alcohol & Culture

International Handbook on Alcohol and Culture

EDITED BY DWIGHT B. HEATH GREENWOOD PRESS Westport, Connecticut London 1995 1 An Introduction to Alcohol and Culture in International Perspective

Dwight B. Heath Alcohol has long been one of the most popular chemicals used by human beings to enhance their moods, and it has been one of the most widespread throughout history. Ironically, it is a tranquilizer, appetizer, disinfectant, anesthetic, food, solvent, and economic commodity, as well as a potent symbol--all in various ways in different cultures. A relatively simple chemical compound, alcohol occurs in nature without any human input and is often appreciated by animals other than humans ( Siegel 1989). Like salt, it is toxic if taken in excessive quantities but, also like salt, it is often refined or diluted and consumed with other substances to make them taste good and to make people feel better. WHY ALCOHOL MATTERS

A chemist can rightly insist that there are several "alcohols," but the one that most interests most people is ethyl alcohol (also known as ethanol, ETOH, or C 2 H 5 OH). It is the only alcohol that people customarily drink--although too often they get methyl alcohol by mistake, and suffer severe gastric disturbances, if not blindness and death. Ethyl alcohol is soluble in water, has no distinctive taste, does no physical harm (in moderate quantities), and is metabolized at the rate of about 7 grams (or 0.3 oz.) per hour in a normal human body, leaving only carbon dioxide (which is what we breathe out anyway) and water. That is a little less than the amount in an average "drink" in the United States in the 1990s--for example, a 12-ounce bottle of beer (at 4%), a 3.5-ounce glass of wine (at 12%), or a 1-ounce shot of spirits (at 86 proof, which is 43%). Drinking larger quantities or drinking faster leads to an accumulation of alcohol for the liver to process, and can result in many kinds of complications. The rapid diffusion of alcohol throughout the system (absorbed in the blood) can affect all -1our senses and abilities, in varying ways and to varying degrees, depending in part on the amount ingested ( Gomberg et al., 1982). The drinking of alcohol in beverages is so unremarkable that, in English as in many other languages, beverages containing very little are often called "alcoholic beverages" (or even "alcohol") not only in common parlance but also in some legal contexts, and even in the

burgeoning multidisciplinary field of "alcohol studies." (To qualify as "nonalcoholic," a beer sold in the United States must contain no more than 0.5% by weight or by volume, a level similar to that found in many fruit juices.) Another indication of the pervasiveness of drinking alcohol as part of the human experience is the fact that, again in many languages, the verb "to drink" often implies alcohol rather than just any liquid. For example, "She drinks, you know" or "He's a drinking man" or "I'll drink to that" ( Heath 1986a). WHY CULTURE MATTERS

As common as the drinking of beverages containing alcohol is, it is often treated as if it were a special kind of behavior ( Marshall 1979). For example, in some cultures, young people are supposed to abstain. In others, women should be very discreet about where, when, with whom, and how much they drink. Men are subject to other, generally less restrictive, norms about drinking. Govemments often fix on alcoholic beverages as special targets for taxation, and both laws and regulations spell out, often in great detail, where they may be sold, when, to whom, in what relation to solid foods, and many other conditions that are considered irrelevant with relation to other drinks. Since the mid- 1940s, there has been a growing scientific interest in various aspects of "alcohol studies"--some have even called for the recognition of a new field, "alcohology." It is intellectually exciting, just as it is scientifically relevant and practically useful, to consider this single substance that is used by people throughout the world in very different ways, for very different purposes, and with very different consequences ( Pittman and White 1991). It is an ideal realm for trying to sort out the distinctions between what is cultural and what is biological, what comes from nature and what from nurture. No matter how thorough a chemical analysis is made of trace elements in alcohol, they have little bearing on the attitudes and values of people who drink it. No matter how complete a psychological assessment can be made of an individual, his or her behavior will change in approximately dose-related ways that tend to be predictable in terms of social norms of the local population. No matter how thorough our understanding of historical and sociological aspects of alcohol use in a given society, it matters whether people are drinking beer (at about 4-12%) or wine (at about 8-20%) or spirits (over 30% alcohol), and how fast they drink it. In short, alcohol is a biopsychosocial phenomenon, and ignoring that complexity can only result in partial understandings, or even misunderstandings. -2THE PURPOSE OF THIS BOOK

This book has been compiled with the aim of providing easier access to information about alcohol in relation to cultures throughout the world. Human populations have always tended to distinguish themselves on the basis of shared understandings about the nature of things, proper relationships among people, right and wrong behaviors in various contexts, links with the supernatural, how to communicate, and many other aspects of life. Such a design for living can be called a culture, and we find many such that differ markedly in some aspects although they may be similar in others. Only during the last few centuries have boundaries and the political apparatus of the nation-state been imposed as an overlay upon the patchwork of human cultures, many of which long preceded nations and most of which still survive and influence the ways people think and act, far more than do state institutions.

In the workaday routine of most individuals, it is aspects of the culture that shape most of what they do, even if they are not particularly aware of it at any given time--for example, in language, gender relations, dress, child rearing, age roles, cuisine, or subsistence activities. At another level, citizenship in the nation can become crucially important in certain contexts-such as obeying the law, serving in the military, getting a passport, or dealing with money. We often talk as if nation and culture are identical, or at least congruent ( Heath 1986b). There is so little cultural variation in Denmark and Iceland, for example, that such a view seems justified. By contrast, cultural variation is so striking in Australia that the authors of that chapter speak of "Aboriginal territory" as quite apart from the European-dominated urban fringe of the country. And the difference is not just a matter of size: Sri Lanka's various distinctive cultures are given far more political, economic, and social importance than the single traditional minority in Sweden. SCOPE OF THE BOOK

An encyclopedic treatment of the subject would be enormous and difficult for anyone to comprehend. But a sampling, designed to provide information on a basic core of subjects, from a limited number of very different countries around the world, can both reveal the rich diversity of roles that alcohol has played in human cultures and allow for meaningful comparisons and contrasts. This book should serve as a basic reference source for students and laypersons, as well as for the international and multidisciplinary scholarly community. Jargon has generally been avoided, and a glossary provides quick identification of those few specialized terms that could not easily be rendered in colloquial English. The straightforward expository style should not, however, be interpreted as implying oversimplification. The bulk of this volume is a series of chapters, each written by a recognized authority (or two), describing the place of alcohol in the culture or cultures of -3a country. Countries were chosen to represent each continent, various government and economic systems, a size range including the largest and some of the smallest, some homogeneous in population and some very diverse. They include not only major urban and industrial nations but also young and developing nations, and a remarkable variety of popular practices and of public policies with respect to beverages containing alcohol. Some countries of obvious interest were left out because they are well described elsewhere; others, because colleagues were reluctant or unable to undertake the burdensome task of writing such a chapter. The culture or cultures within each country that are described were chosen by each author independently. As an anthropologist, I might have devoted more attention to various tribal or peasant groups, but it is interesting to see how the concept of culture was viewed as congenial and appropriate by colleagues in other fields. The chapters are not identical in outline, but they usually include some historical context, dominant patterns of alcohol use and some variant usages among different populations, how social and demographic factors (such as age, sex, socioeconomic class, schooling, income) affect drinking and its outcomes, and legal, regulatory, and policy issues. Some of the authors offer recommendations for action.

It was no surprise that each country presents a unique and distinctive combination of factors that relate to the importance of alcohol there. It was a surprise, however, that many of the contributing authors chose to ignore a standard outline that might have facilitated comparisons and contrasts because they felt that it would hamper their presentations. As an editor, I have conscientiously let each of the authors speak with his or her own voice rather than homogenizing them to an unnatural uniformity. Minor stylistic revisions have been made in the interest of clarity and comprehension, but the organization and content of each chapter, and the tone of each author, remain intact. This explains why some chapters may seem so favorable toward drinking and some so critical, some quite liberal in their evaluations and recommendations, and some authoritarian. On a very few occasions, I have inserted brief editorial comments, located at the end of a chapter, to inject an editorial note where it seems crucial to understanding, or where the author's view appears to differ from that of mainstream Western science. FORMAT AND USE OF THE BOOK

A reader who wants to learn about drinking in a given country will find that the chapter in this book is the most recent and authoritative source that is easily accessible. Almost every chapter includes a list of selected references that will be helpful to anyone who chooses to pursue the subject in greater detail. In quantitative terms, the chapters differ considerably. This is partly a reflection of the fact that nations and cultures differ in terms of how people treat alcohol, and what it does to them. It also reflects the significant differences among -4nations in terms of numerical data that are available. This is partly a function of the wealth that a government (or police system, or hospital, or other agency) chooses to devote to enumeration. It is partly a function of how important research is thought to be (in competition with other demands on limited resources). One might even argue that it reflects a people's view of how important--or unimportant--numbers may be in relation to other ways of knowing. Any reader who is unfamiliar with the meaning and significance of the numerical index known as per capita consumption, which so many authors cite, should read the Appendix for a simple explanation, together with large-scale international comparison. In qualitative terms, there is also some variation. It is evident that the authors are practicing scientists and other professionals in many different fields. Readers should also keep in mind that English is, at best, a second language for most of them. Following the twenty-seven national chapters are two chapters by the editor. One provides an anthropological overview of alcohol use, emphasizing linkages with other aspects of culture. The other points out some of the more striking regularities that occur among the countries that have been described by local authorities, and offers some tentative generalizations. In the hope that journalists, legislators, and others who play active roles in shaping and communicating policies will pay attention to the value of these accounts as "natural experiments," I also mention some of the policy implications that derive from so much experience. A brief appendix both illustrates the wide range of per capita consumption figures for various countries and explains the strengths and some of the shortcomings of such figures. A glossary provides definitions of words that are used in distinctive ways in various parts of this book;

some are specific to an individual country, and some are terms that have special meanings in relation to alcohol studies. The bibliographic essay is intended to help anyone who wishes to pursue the subject in greater depth. With no pretense at being complete or encyclopedic, it aims at guiding the reader to a few key sources, most of which are available at any major research library, for original writings, both descriptive and analytic, by authoritative specialists. "About the Editor and Contributors" gives brief information about each of the authors and the editor, emphasizing present affiliation so that they can be contacted by interested readers, rather than simply chronicling their many and varied achievements. The index is intended to help the interested user, even one with little prior knowledge of the subject, to find relevant information on concepts, types of beverages, social groups, cultures, religions, and other topics. Abundant use of cross-referencing avoids the problem that might arise from too much use of a specialized vocabulary or jargon. In a sense, an international handbook should be viewed as a tool, with the -5measure of its worth being the success of those who use it. The contributors join me in hoping that these essays will be helpful, no matter what your reason for seeking them out. REFERENCES

Gomberg Edith L., Helene R. White, and John A. Carpenter (Eds.). 1982. Alcohol, Science and Society Revisited. Ann Arbor: University of Michigan Press. Heath Dwight B. 1986a. "Cultural definitions of drinking: Notes toward a semantic approach". The Drinking and Drug Practices Surveyor 21:17-22. -----. 1986b. Concluding remarks. Pp. 234-237 in Thomas F. Babor (Ed.). Alcohol and Culture: Comparative Perspectives from Europe and America. Annals of the New York Academy of Science472. New York: NYAS. Marshall Mac (Ed.). 1979. Beliefs, Behaviors, and Alcoholic Beverages: A CrossCultural Survey. Ann Arbor: University of Michigan Press. Pittman David J., and Helene R. White (Eds.). 1991. Society, Culture, and Drinking Patterns Reexamined. New Brunswick, N.J.: Rutgers Center of Alcohol Studies. Siegel Ronald K. 1989. Intoxication: Life in Pursuit of Artificial Paradise. New York: E. P. Dutton. -63 Canada

Yuet W. Cbeungand Patricia G. Erickson To many Canadians, enjoying a hockey or baseball game on TV with friends, drinking beer, shouting and cheering for the favorite team, is a familiar social gathering scenario. Indeed, drinking is a popular activity among Canadians, especially on social recreational occasions. In 1989, an estimated 78% of Canadians fifteen years or older had taken at least one drink in the previous year ( Health and Welfare Canada 1990). In that same year, the mean consumption was approximately 9.5 liters of pure alcohol for every drinker aged fifteen or older, and the value of sales of alcoholic beverages was $9,896 million, about U.S. $8.4 billion ( ARF 1992). The level of alcohol consumption in Canada is higher than in most South American, Asian, and African countries, although compared with other Western countries, it is probably in the medium range. Before we further describe the current drinking pattern in Canada, a brief introduction to the history of alcohol use in Canada is in order. It was believed that before the arrival of the Europeans, native inhabitants in the land now called Canada were totally abstinent ( Smart and Ogbome 1986). When trade was established between Indians and Europeans, brandy and rum became major commodities sought by the former. Native peoples became the first heavy drinkers in Canada. Heavy drinking also was an aspect of the lives of early European settlers, especially lumbermen, miners, boatmen, and railwaymen. In the mid1700s, liquor became a source of government revenue. The church also held a permissive attitude toward drinking. Taverns and wayside inns, abundant throughout Canada, were places where excessive drinking often took place. Per capita alcohol consumption was probably 25-30% higher than it is today. Alcohol use in Canada did not become a social issue until the early decades of the 1800s, when the temperance movement began. Alcohol was identified by the movement as the root cause of moral degradation and all kinds of social -20problems. Supporters of the movement were mainly middle-class, Anglo-Saxon, Protestant fundamentalist, and rural; they believed that prohibition of alcohol would eradicate the major social evils in society. Temperance societies proliferated throughout the country except in Quebec, where the Catholic Church was more in favor of moderate drinking than of complete prohibition. In spite of opposition from drinkers and those involved in the sale and distribution of alcohol, the temperance movement culmulated in the prohibition of drinking in all ten provinces early in the twentieth century. Except for Prince Edward Island, which passed prohibition laws in 1907, all other provinces started prohibition in the late 1910s. But the success of the prohibitionists was short-lived. As people continued to drink, an active illegal market for alcohol distribution was engendered. Prohibition laws were difficult to enforce. More important, poverty, crime, disease, and other social miseries did not disappear with prohibition. Changes in the demographic structure of the Canadian population during the postwar years, due to increasing numbers of immigrants and city dwellers, also undermined public support for prohibition, which had greater appeal to rural, middle-class, Protestant fundamentalists. Except for Prince Edward Island, which was the strongest holdout for prohibition ( 1907-1948), other provinces repealed prohibition in a relatively short time, ranging from only one year for Quebec ( 1918-1919) to thirteen years for Nova Scotia ( 1916-

1929). The failure of prohibition marked the end of the biggest and longest social movement in Canadian history. CONTEMPORARY DRINKING PATTERNS

Although prohibition of drinking was a "great experiment that failed," it did bring about a reduction in the rates of drunkenness and deaths from alcoholism in the several decades that followed. From the 1930s to the 1960s, surveys of alcohol use were scanty and scattered. One source of data on drinking habits has been the Gallup Poll, which found in its surveys that the percentage of drinkers (ever used alcoholic beverages) twenty-one years and over increased from 59% in 1943 to 65% in 1958, and the percentage of drinkers eighteen years and over increased from 67% in 1969 to 78% in 1978, then dropped to 73% in 1983 ( Smart and Ogbome 1986). Since the 1970s, large-scale national and provincial surveys have collected a large amount of information on the drinking patterns of Canadians. General Prevalence Trends

Three national surveys on health and related issues have been conducted since 1978 by Health and Welfare Canada. These are the 1978/79 The Health of Canadians ( Health and Welfare Canada 1981), the 1985 Canada's Health Promotion Survey ( Health and Welfare Canada 1988), and the 1989 National Al-cohol and Other Drugs Survey -21cohol and Other Drugs Survey ( Health and Welfare Canada 1990). The last was the first national survey to focus exclusively on alcohol and other drug issues. All three national surveys asked the respondent whether he or she was a current drinker, defined as one who had taken at least a drink in the year preceding the survey. Results showed a trend of slight decline in the estimated percentage of current drinkers age fifteen or over, from 82% in 1978/79 to 81% in 1985, to 78% in 1989. There were fewer abstainers in 1989 than before (7%, compared with 8% in 1985 and 13% in 1978/79), but more Canadians had stopped drinking for at least a year (15%, compared with 10% in 1985 and 4% in 1978/79). Among current drinkers, there was a decline in the proportion of "frequent drinkers" (those who drink alcohol at least once per month), from 67% in 1978/ 79 to 61% in 1985 and 52% in 1989, and an increase of "occasional drinkers" (drink alcohol less than once per month) from 15% in 1978/79 to 20% in 1985 and 26% in 1989. Current Drinking Habits and Attitudes

The richest collection of information on current drinking habits, attitudes toward drinking, and alcohol-related problems in Canada was gathered by the above mentioned 1989 National Alcohol and Other Drugs (NAD) Survey, which interviewed by telephone 11,634 respondents fifteen or older in randomly selected households in ten provinces (Yukon and the Northwest Territories were excluded). Data for this chapter on the current drinking situation in Canada were mainly extracted from that survey (see Health and Welfare Canada 1990; ARF 1992).

How frequently and how much do Canadians drink? About a quarter of current drinkers (those who had taken at least a drink in the twelve months preceding the survey) drink less than once per week, another quarter drink less than once per month, 38% drink one to three times per week, and 11% consume four or more drinks per week. On the average, a current drinker consumes 3.7 drinks per week. Half of the current drinkers had not consumed five or more drinks on one occasion in the last twelve months. The most popular alcoholic beverage consumed by Canadians is beer, followed by spirits and wine. In 1989-90, the sale of beer accounted for $4,981 million (about U.S. $4.2 billion, 50% of total sale of alcoholic beverages); that of spirits and wine accounted for $3,174 million (U.S. $2.7 billion, 32%) and $1,741 million (U.S. $1.5 billion, 18%), respectively. The most popular drinking setting for Canadians is a bar or tavern; almost three-quarters of current drinkers always drink whenever they visit such places. Canadians are also likely to drink at parties, weddings, and other social gatherings (half of current drinkers do), and in a restaurant while having dinner (almost one-quarter of current drinkers do). Drinking is much less likely to take place at home, during lunch at a restaurant, or at concerts or sporting events. -22Canadians do not like to drink alone. The most common drinking companions are friends, followed by spouse/partner and family members (other than spouse)/ relatives. About half of the current drinkers drink with their friends a few times per month or more, three-tenths of them drink with their spouses that frequently, one-quarter drink with their family members/relatives, and slightly more than one-tenth drink with coworkers. Less than onetenth of current drinkers drink by themselves once per week or more, and they are more likely to be older or heavy drinkers. Because much drinking takes place in bars/taverns and at parties/social gatherings, and many Canadians drink with friends or spouse/relatives, it is not surprising that they hold a permissive attitude toward drinking in bars/taverns and on social occasions. Almost 60% of all respondents of the 1989 NAD Survey feel that it is acceptable for a man to take one to two drinks in a bar with his friends, and 22% think it is permissible for a man to drink enough to feel the effects of alcohol in that context. A woman drinking at a bar with friends is also acceptable, although a smaller percentage (16%) permit woman to drink enough to feel the effects in that context. Drinking enough to feel effects at parties or social gatherings is as acceptable as drinking at a bar with friends. However, when it comes to work-related contexts, Canadians are much more restrictive about drinking. For example, almost 60% of respondents believe that coworkers should not drink when they are out to lunch. Generally speaking, the norms of male drinking and female drinking are not the same. In almost all drinking contexts, Canadians hold a more permissive attitude toward drinking by males than drinking by females. In sum, drinking is prevalent among Canadians; an estimated 78% of Canadians fifteen years or older are "current drinkers," consuming an average of 3.7 drinks per week. Drinking is very much a social recreational activity, the most common contexts for drinking being the

bar/tavern and social gatherings, and alcohol being always consumed with friends or spouse/family members/ relatives. Canadians generally hold a permissive attitude toward drinking on social occasions, although male drinking is more acceptable than female drinking. Drinking in work-related settings is not acceptable. These findings suggest that alcohol use is very much part of the socialization in the family, among peers, and in the workplace. Sociodemographic and Regional Variations in Drinking

Underneath the general patterns of alcohol use in the Canadian population are quite a few sociodemographic and geographic variations. Region

In general, alcohol use is more prevalent in western provinces than in eastern provinces. For example, British Columbia in the west has the highest proportion of current drinkers (83%), and Prince Edward Island in the east has the lowest -23proportion (64%). The proportions of current drinkers in Manitoba and Saskatchewan, two provinces in central Canada, are 79% and 78%, respectively. However, the average number of drinks consumed by a current drinker per week is highest in Ontario and Quebec (both 3.9), although the percentage of current drinkers in these two provinces is close to the Canadian average (78% for Ontario and 76% for Quebec). The average number of drinks per week consumed by a current drinker in British Columbia is 3.8, and that in Prince Edward Island is 3.1. Gender

In Canada, as in many other countries, men are more likely to consume more alcohol than women. In the 1989 NAD Survey, 84% of men were current drinkers, compared with 72% of women. Men also consume alcohol more frequently and in larger quantities than do women; 15% of male current drinkers drink four times or more per week, whereas only 6% of female current drinkers do. The average number of drinks per week consumed by male current drinkers is 5.3, compared with 2.0 for female current drinkers. Age

In general, age is inversely related to prevalence of alcohol use. The percentage of current drinkers is highest in the youngest subgroup of 15-34 (84%), decreases to 80% for 35-54, and drops sharply (63%) for fifty-five or more. The greatest average number of drinks per week (4.3) is found in the 20-24 and the 45-54 subgroups. The 15-19 subgroup consumes the smallest average number of drinks per week (2.4). Marital Status

Married, separated, and divorced Canadians have similar percentages of current drinkers (79%, 76%, and 78%, respectively). The highest percentage of current drinkers (82%) is

among those who have never been married, probably because this subgroup of people is the youngest. Widowed Canadians have a much lower percentage of current drinkers (49%) than other subgroups, probably because this subgroup has the largest proportion of older people. Among all the subgroups, those who are separated consume the highest average number of drinks per week (5.2), followed by those who are divorced (4.4) and never married (4.3). Education

There is a substantial difference in the percentage of current drinkers between Canadians whose education level is secondary school or less and those with postsecondary schooling. Those with secondary schooling or less have a smaller proportion of current drinkers (73%), whereas the proportion for those with some postsecondary schooling is 87% and that for those with a postsecondary degree is 86%. Although level of education seems to be positively associated -24with prevalence of alcohol use, those with the highest level of education (postsecondary degree) consume fewer drinks per week (3.6) than those at other education levels (3.8 for secondary or less and 4.2 for some postsecondary). Occupation

Alcohol use is more prevalent among Canadians who are in the work force or are looking for jobs than among those who are not. Among employed Canadians, managers/professionals have the highest percentttge of current drinkers (88%), followed by blue-collar workers (86%). However, blue-collar workers consume more drinks per week (5.8) than managers/professionals (3.8). Among those not in the work force (students, retirees, and homemakers), students have the highest percentage of current drinkers (77%), compared with 59% of retirees and 63% of homemakers. However, retirees consume more drinks per week (3.8) than the other two subgroups (2.6 for students and 1.5 for homemakers). Income

Household gross annual income is positively related to alcohol consumption. The proportion of current drinkers is 60% in the lowest income subgroup (less than $10,000 [U.S. $8,5001), rising to 66% in the $10,000-$19,999 [U.S. $8,500-16,9991 subgroup, 80% in the $20,000$39,999 [U.S. $17,000-33,9991 subgroup, and 89% in the highest income subgroup ($40,000 or more [over U.S. $34,000]). The average number of drinks per week consumed also increases with income, from 2.7 in the lowest subgroup to 4.2 in the highest subgroup. Ethnicity

Canada is a multiethnic society, with people of British and of French descent being the two earliest and dominant nonnative ethnic groups. Immigrants from other parts of Europe came in large numbers in the last two centuries. Since the 1960s, growing numbers of immigrants from Central and South America, Asia, the Middle East, and Africa have arrived, significantly changing the ethnic composition of the country. The country is also divided

along linguistic lines, with French being the dominant language in the province of Quebec and English being spoken in most other parts of the country. Apart from these two official languages, ethnic languages are widely used among different groups, especially by immigrants who have little knowledge of either of the two offical languages. In spite of the enormous ethnic variations in the Canadian population, very few research efforts have been made to document the prevalence of alcohol consumption and alcoholrelated issues in different ethnic groups. Some insights can be gained by examining the data of the 1989 NAD Survey, although meaningful comparisons of alcohol use among ethnic groups await more sophisticated research. The survey asked respondents what language they most often spoke at home, and what ethnic or cultural group they belonged to. The former ques-25tion assesses whether the respondent is English-speaking (an anglophone), French-speaking (a francophone), or neither (i.e., a user of ethnic language only). The latter information is a respondent's subjective identification with an ethnic group or heritage. If a respondent could not name a group that he or she identified with, he or she was assumed to be significantly acculturated to mainstream Canadian culture and to retain little ethnic culture. Those who mentioned a group without making reference to the Canadian identity (i.e., not a "hyphenated Canadian") are likely to be recent immigrants and to retain and practice a large amount of the ethnic culture. Findings show that anglophones and francophones do not differ significantly in the proportion of current drinkers (79% for anglophones and 77% for francophones). Ethnic language users have the smallest percentage of current drinkers (66%). Anglophones and francophones consume an equal number of drinks per week (3.8); ethnic language users consume fewer drinks per week (3.2). Regarding ethnic group identification and alcohol use (figures obtained from the analysis in Cheung and Eliany 1992), those not identifying with any particular ethnic group have 79% current drinkers. Among those who identified with an ethnic group, without making reference to the Canadian identity, the Ukranian/Polish subgroup has the largest percentage of current drinkers (82%), followed by the German/Dutch subgroup (80%). Contrary to popular stereotypes, the Irish, the Scottish, and the Italian/Portuguese subgroups all have lower, rather than higher, percentages of current drinkers (73% for Irish and 76% for Scottish and Italian/Portuguese) than the Canadian average. The English and French subgroups have similar percentages of current drinkers (79% and 78%, respectively). Those who gave "other" group identities (Jewish, Chinese, and others) have the smallest percentage of current drinkers (72%). Native peoples in Canada have been known to consume more alcohol and have more alcoholrelated problems than other Canadians. Although there have been many studies of alcohol use among Indians and other native peoples in Canada, no large-scale alcohol and drug epidemiological survey has been conducted. Alcohol sales data for Yukon and the Northwest Territories, inhabited mainly by native peoples, suggest that the levels of alcohol use of the native peoples are high ( ARF 1992). For example, the number of drinks per week per person aged fifteen and over, computed from sales data, for Canada as a whole was 12.5 in 1980-81, 11.7 in 1984-85, and 11.2 in 1988-89. The consumption rate was twice as much in Yukon:

26.9 in 1980-81, 20.9 in 1984-85, and 20.1 in 1988-89. The rate in N.W.T. was lower than in Yukon but still substantially higher than the Canadian average: 15.4 in 1980-81, 15.7 in 1984-85, and 14.6 in 1988-89. ALCOHOL-RELATED PROBLEMS

Canadian drinkers experience a variety of personal and social problems as a result of their drinking. Among the current drinkers in the 1989 NAD Survey, -2612% reported that they had at some time in their life felt that their alcohol use had a harmful effect on their physical health. Difficulties with friendships or social life was the next most common consequence of drinking (experienced by 11% of current drinkers at some time in their life). Other problems resulting from alcohol use reported by 2-6% of drinkers included negative outlook on life, financial difficulties, problems with marriage or home life, and problems with employment or studies. Further analyses of the 1989 NADS data ( Single and Wortley n.d.; Cheung and Eliany 1992) show that, although some sociodemographic variables (e.g., gender, age, education, income) correlate significantly with alcohol-related problems, a drinker's total alcohol consumption and extent of heavy drinking are most predictive of his or her lifetime alcohol-related problems and alcoholrelated problems in the last twelve months. In Canada, alcohol is a cause of a variety of physical problems ( ARF 1992). In 1988, the number of alcoholics (based on the Jellinek estimation calculated from cirrhosis deaths) was estimated at 476,800, or 2,600 alcoholics per 100,000 population age twenty and over (excluding Yukon and N.W.T.). This alcoholism rate has been dropping since the mid-1970s, from 4,200 alcoholics per 100,000 population age twenty and over in 1975 to 3,700 in 1980, and to 2,800 in 1985. During 1987-88, the total number of discharges from Canadian general hospitals of patients with an alcohol-related diagnosis was 36,872, 67% of which were for mental disorders and 30% for diseases of the digestive system. The rate per 100,000 population age twenty and over was 200.6. This represents a drop of 7.2% from the previous year. The rates of alcohol-related mental disorder cases and alcohol-related diseases of the digestive system cases have been declining. For example, the rate for alcohol dependence syndrome cases per 100,000 population aged twenty and over was 105.5 in 1984-85 and 88.0 in 1987-88. The rate for alcohol-related chronic liver disease and cirrhosis cases per 100,000 population age twenty and over was 30.1 in 1984-85 and 29.2 in 1987-88. Data on alcohol-related problems in the native population are scattered and incomplete, although many studies have found high rates of alcohol-related diseases and disabilities among native peoples. One compilation of data ( ARF 1992) indicates that the alcohol-related mortality in Yukon and N.W.T. is higher than the Canadian average. The percentage of deaths from direct alcohol-related problems relative to total deaths for all diagnostic categories for Canada as a whole was 1.7 in 1986 and 1.6 in 1989. That for Yukon was 4.4 in 1986 and 4.2 in 1989; that for N.W.T. was 3.0 in 1986 and 2.0 in 1989.

Alcohol intoxication is one of the major contributory factors in traffic accidents. The rate of drinking-and-driving offenses per 100,000 population age sixteen and over was 677.1 in 1990. Like alcohol-related physical problems, the rate of drinking-and-driving offenses dropped during the 1980s: 878.6 in 1983, 770.1 in 1986, and 708.7 in 1989. Yukon and N.W.T. had much higher rates -27than the rest of Canada: 4,102.4 and 1,798.7, respectively in 1983, and 3,473.7 and 2,941.3, respectively, in 1990. In sum, there has generally been a decline in the rates of alcoholism, alcoholrelated physical problems, and drinking-and-driving offenses in Canada since the 1970s. The decline is concomitant with the decrease in alcohol consumption in the same period. ALCOHOL POLICIES Control Policies

Although the federal government is in charge of the manufacture, import, and export of alcoholic beverages, each province regulates the marketing and distribution of alcohol within its boundaries. This has meant considerable variation in control policies across Canada. Each of the ten provinces has a monopoly on the off-premises sale of spirits, imported wine, and beer. Domestic wine and beer are sold through both monopoly and private outlets. Quebec permits the sale of beer and wine in grocery stores; a similar recent initiative in Ontario was defeated. The number and types of on-premises outlets, as well as hours of sale, have generally been increasing since the 1950s. Self-service has replaced ordering from clerks. The price of alcoholic beverages in real dollars (unaffected by inflation) has been growing cheaper in Canada since the 1960s. These various components of the liberalizing trend in alcohol availability likely contributed to the increase in alcohol consumption from 1950 to the mid-1970s ( Single et al. 1981). During the period between 1970 and 1975, the drinking age was lowered from twenty years in Quebec and from twenty-one years in all the other provinces. The legal drinking age is now eighteen years in about half the provinces and nineteen in the rest. Although parents are permitted to serve alcohol to underage children in their own homes, legal penalties exist for underage drinkers and those who supply them in other settings. Advertising of alcoholic beverages has been a controversial issue in Canada. By federal law, beer and wine commercials, but not those promoting spirits, are permitted on radio and television. This resulted in the distillers' launching a charter challenge [Ed. note: a lawsuit charging unconstitutionality] that such a ban was an infringement of their industry's right to equal treatment. As of 1995, the final ruling had not been given. The sponsorship of sports and other cultural events by the alcoholic beverage industry is widespread in Canada. Advertising regulations vary by province, and numerous guidelines restrict the types, content, and location of ads. Generally, Canada permits far less alcohol advertising than is commonplace in most parts of Europe and the United States ( Smart and Ogbome 1986).

Public attitudes toward alcohol control policies were assessed in the NAD Survey ( Health and Welfare Canada 1990). A majority of 74% favor both the -28continued ban of alcohol sales in grocery stores and the introduction of warning labels on alcoholic beverages. About half (51%) support a complete ban of alcohol advertising on radio and television. Respondents are more likely to favor an increase both in alcohol taxes (27% vs. 18% for a decrease) and the drinking age (50% vs. 3% approving a decrease). More respondents agree with a proposal to decrease permitted hours of operation of government monopoly stores than would expand business hours (17% vs. 7%). Thus a majority of Canadians appear to oppose the "liberalizing" trends of past decades. Prevention and Treatment Policies

There is a trend in Canada toward more comprehensive prevention programs that include a variety of psychoactive substances. Such programs are usually seen as part of provincial jurisdiction over health. The majority of programs are school-based, but some advertising campaigns have been developed that center on health promotion. Public attitudes support educational methods for the prevention of alcohol problems: 61% favor an increase in antidrinking advertisements; 82% support more server training (to stop serving alcohol to intoxicated persons); 81% want more government prevention programs ( Health and Welfare Canada 1990). In Canada, treatment directions have shifted away from more expensive, specialized inpatient care to a mix of in- and outpatient services. These include detoxification facilities, long- and short-term residential facilities, and a variety of outpatient programs. Alcohol dependency and related problems are dealt with in a broader system of universal health care accessibility. Treatment for alcohol problems is widely available, but the vast area of the country means that access is more limited in sparsely populated areas than in urban centers. Self-help groups are also numerous, and Canada has a high proportion of Alcoholics Anonymous groups compared with most other countries. In conclusion, Canada has been a leader in the recognition that many alcohol problems are self-inflicted "lifestyle" diseases. The most effective approaches, in the long run, are likely to be basic prevention, early intervention, and health promotion strategies. REFERENCES

Addiction Research Foundation. 1992. Canadian Profile: Alcohol & Other Drugs. Toronto: Addiction Research Foundation. Cheung Yuet W., and Marc Eliany. 1992. "Predicting alcohol use and alcohol-related problems in Canada: How useful are socio-demographic variables?" Toronto: Addiction Research Foundation. Health and Welfare Canada. 1981. The Health of Canadians: Report of the Canada Health Survey. Ottawa: Ministry of Supply and Services of Canada. -29-

-----. 1988. Canada's Health Promotion Survey: Technical Report. Ottawa: Ministry of Supply and Services of Canada. -----. 1990. National Alcohol and Other Drugs Survey: Highlights Report. Ottawa: Ministry of Supply and Services of Canada. Single Eric, Norman Giesbrecht, and Barry Eakins. 1981. "The alcohol policy debate in Ontario in the post-war era", Pp. 127-157 in Eric Single, Patricia Morgan, and Jan de Lint (Eds.). Alcohol, Society and the State, vol. 2, The Social History of Control Policy in Seven Countries. Toronto: Addiction Research Foundation. Single Eric, and Scot Wortley. 1993. "Drinking in various settings as it relates to demographic variables and level of consumption: Findings from a national survey in Canada". Journal of Studies on Alcohol 54: 590-599. Smart Reginald G., and Alan C. Ogborne. 1986. Northern Spirits: Drinking in Canada Then and Now. Toronto: Addiction Research Foundation. -30-

26 The United Kingdom

Martin A. Plant The United Kingdom (UK) consists of England, Wales, Scotland, and Northern Ireland ( Ulster). Its population is approximately 55.4 million, of whom 46 million reside in England. Scotland has a population of just under 5 million. The populations of Wales and Northern Ireland are roughly 2.8 million and 1.6 million, respectively. The UK has a single government, based in London. Even so, the four main component parts of the UK have longestablished, highly distinctive national traditions and cultural identities. Moreover, within the individual countries that make up the UK there exists a profusion of local and regional social and cultural variations. In some areas of Wales the Welsh language still thrives, as does Gaelic in certain parts of northwestern Scotland. The cultural diversity of the UK has been further enriched by postwar immigration, most notably from the Caribbean and from the Indian subcontinent. Alcohol has long been established in the UK as a whole. Its entrenchment is so great that, as Mandelbaum ( 1967) noted, the word "drink" is frequently assumed to imply an alcoholic beverage. The importance of alcohol in the UK is emphasized by the fact that approximately 750,000 people are engaged in its production, distribution, and sale. In spite of the widespread use and general (but not total) acceptance of alcohol, the UK may be grouped with those mainly Protestant cultures in which there is considerable ambivalence about drinking. As this chapter will elaborate, the UK, like several northern European countries, the United States, Canada, Australia, and New Zealand, is a country in which per capita alcohol consumption is not especially high but alcohol misuse has long been regarded as a major national problem. In spite of this, "the alcohol debate" in the UK is probably less polarized

than that in most countries in which a large proportion of the population refrains from alcohol consumption and temperance movements exert greater influence. -289BRIEF HISTORY

The earliest records of human presence in the British Isles date back to Paleolithic times. Human expansion was limited by glaciation. The northern areas were settled later than those in the south. Murray ( 1973) notes that human settlement in Scotland was not in evidence until the postglacial period, around 6400 B.C. Ireland also was uninhabited during the Ice Age. Neolithic people arrived in Britain from continental Europe. Subsequent waves of immigrants followed. These included Picts, Celts, Saxons, Romans, Vikings, and Normans. The Romans established a network of strategically placed tabernae along their roads in Britain. These buildings, primarily designed to provide food and shelter, also sold wine. By the Middle Ages, alehouses or taverns were commonplace. Such establishments provided little more than ale for travelers. Alcohol use was well established in the Middle Ages, as noted by Spring and Buss ( 1979, 22): "Ale has been drunk in England since Celtic times and hopped beer since the fifteenth century." Alcohol consumption in medieval Britain was, by modern standards, very high. However, much of the ale and wine then available was probably weak, and alcoholic drinks were often safer to consume than water or milk, given the sanitary conditions of the times. The latter became relatively safe to drink only in the late 1800s, with purification and pasteurization. There is clear evidence that in Britain of the 1300s, the daily consumption by adult males of one or two gallons of ale per day was not uncommon. Warner ( 1992, 8) notes: about all of the sources say that the heaviest drinking occurred in northern Europe, that is in those regions where Protestantism and the various temperance movements later scored their biggest successes. The English were by far the heaviest drinkers, or so our sources, most of them French, would have us believe. She also reports that although women in medieval England commonly drank alcohol, they rarely did so in taverns. Williams and Brake ( 1982) have commented that alehouses gradually evolved into small pubs (public houses) that largely catered to local residents. Inns, too, were widespread in England in the Middle Ages. These were distinguished from taverns by the fact that taverns initially provided sleeping facilities but no food. The difference between inns and alehouses (or taverns) became blurred by the 1500s. The same authors commented that "better class inns" were numerous in English towns by the 1600s. Such establishments reflected an increase in travel. Inns were numerous between the 1500s and 1700s, especially in towns along the major routes of travel and trade. Inns became social centers after the emergence of the country gentry as a leisured class. The image of the urban inn changed for the worse during the 1700s and 1800s. The "gin epidemic" of the 1700s, associated with rapid urbanization and the Industrial Revolution, did much to bring the popular image of the urban

-290public drinking place into disrepute. It was a notorious example of unrestrained alcohol sale and consumption. During the reign of Queen Anne, the monopoly of the Worshipful Company of Distillers was ended. This was followed by unrestricted production of often lowgrade gin. In consequence, gin consumption soared, in association with widespread problems. A system of retail licensing was introduced in 1729. This curbed consumption but was repealed four years later. New legislation restricted the selling of spirits outside dwelling houses. The effect of this was to foster the spread of "gin shops." As noted by Spring and Buss ( 1979, 25), "Thus gin and other crude spirits were both cheap and readily available at a time when the social conditions of the urban poor were extremely hard with little hope of escape other than intoxication." Legislation was introduced in 1751 and 1792 that increased duty on spirits and controlled the number of public houses in England. Significantly, the latter legislation was entitled The Disorderly Houses Act. The consumption of spirits rose considerably during the 1800s, reaching a peak around 1880. Wine consumption was more stable, but also rose between 1860 and the 1870s. Tea and coffee consumption also rose, but were modest in comparison with that of alcoholic drinks. Harrison ( 1971, 69) reported that per capita consumption in England and Wales was as follows in 1834: "Only 1.41 lb. of tea and 0.96 lb. of coffee per year, as opposed to 23.1 gallons [about 27.7 U.S. gal.] of beer and 1.13 proof gallons of spirits [equivalent to about . 775 U.S. gal. or 3.41 liters of pure alcohol]. Increasing alcohol consumption and a proliferation of licensed premises were accompanied by widespread alcohol misuse. Concern about drunkenness in Britain had periodically been expressed since before medieval times. Even so, only during the 1800s did an influential movement favoring total abstinence emerge. It has been described in detail by Harrison ( 1971). This movement was greatly influenced by Anglicans and Nonconformists. It was also encouraged by American temperance campaigners. Initially an anti-spirits movement, the temperance campaign was closely allied with the anti-slavery movement. Alcohol and slavery were seen as parallel evils. Concern about alcohol problems reached high levels during the 1800s. One of the first major scientific essays on this topic was produced by the British physician Thomas Trotter in 1804. Trotter suggested that chronic drunkenness was a disease. By the 1850s, an active prohibitionist movement, the Alliance, was urging the end of alcohol production and consumption in Britain. Legislation was introduced in 1872. This made magistrates the sole licensing authority and limited the hours licensed premises could be open. The effects of this act, together with vigorous public campaigning, are uncertain. Even so, the number of licensed premises declined after 1870 and per capita alcohol consumption began to fall around 1876. Many of the problems associated with urban public houses were simply reflections of the social conditions endemic in towns during the Industrial Revolution. Widespread prostitution and cruelty to animals (in the form of dog fights for gambling) were both associated with the Victorian pub, -291which came to be an extremely important social center for the poor, whose living places were miserable.

After this period the temperance movement lost much, but by no means all, of its influence. Developments in the UK during the 1900s were far less dramatic than was the introduction of total prohibition in the United States. Other laws were introduced during the twentieth century. They limited public bar opening hours and (in 1908) forbade entry into bars by children under the age of fourteen. During World War I, public house opening hours were further restricted, and the alcohol content of beer was reduced. These and other measures were ostensibly introduced to prevent the war effort from being impeded by heavy drinking. In 1923, it became an offense to sell alcoholic beverages to those below the age of eighteen, which remains the minimum age for purchase in the UK. However, it is not illegal for those aged five and above to drink outside licensed premises. National differences in drinking styles and cultures have always been evident within the UK. As late as 1982, two of the thirty-seven licensing areas of Wales did not allow public houses to sell alcohol on Sundays. Until 1976, public houses in Scotland closed earlier than in England and Wales, and were closed on Sundays. Public bar standard measures of spirits still vary in different parts of the UK. Two committees have examined licensing arrangements in Britain. One of these related to England and Wales ( Errol 1971); the second, to Scotland ( Clayson 1972). Both reports adopted a social integrationist position and recommended relaxing the current system of licensing, which had largely been established during World War I. The Licensing (Scotland) Act of 1976 allowed public houses to stay open after 10 P.M. and to open on Sundays. Flexible opening hours have been permitted since 1977. The impact of these changes on health appears to have been neutral ( Duffy and Plant 1980). Licensing arrangements in England and Wales were slightly relaxed during 1988. Further minor changes in Scottish licensing were introduced in 1990. These extended the permitted weekday afternoon opening hours. Other legislation has been introduced in response to public concern about alcohol problems. The Road Safety Act (1967) introduced breath-testing for drivers who had been involved in accidents, who had committed a moving traffic offense, or who were suspected of having consumed alcohol. Recently drunken driving in Britain has decreased, and there is strong public support for the introduction of random breath-testing to detect intoxicated drivers. The Criminal Justice (Scotland) Act of 1980 banned the taking of alcoholic beverages into sports grounds and restricted the carrying of alcohol on public transport associated with sport. Similar restrictions for England and Wales were introduced under the Sporting Events (Control of Alcohol etc.) Act (1985), largely in reaction to hooliganism by crowds at sporting events. More recently several towns, including Coventry, Dundee, and Motherwell, have introduced bylaws banning the consumption of alcoholic beverages on the streets in certain defined areas. -292ALCOHOL CONSUMPTION PATTERNS

Trends in alcohol consumption in the UK since 1700 have been described by Spring and Buss ( 1979). There have, over time, been major changes in levels of per capita consumption. Beer consumption was vastly higher during the early 1700s than it has been since, and spirit consumption reached a peak during the notorious "gin epidemic." More recent alcohol consumption reached a low point after World War I and during the Great Depression of the 1930s. After World War II per capita consumption increased, virtually doubling by its peak year, 1979. The level of per capita alcohol consumption in the UK is much lower than that of

France, Spain, Italy, Belgium, Denmark, and Germany. In 1989, UK per capita consumption of absolute alcohol was 7.3 liters. This was similar to that of New Zealand, Canada, and the United States, but higher than that in Eire and the Nordic countries ( Brewers Society 1991). In spite of its middle-of-the-road level of alcohol consumption, concern about alcohol problems is higher in Britain than in many countries where per capita alcohol consumption is much higher. This concern reflects a variety of social, religious, and cultural factors. It also reflects the commonplace nature of drinking to intoxication, which particularly involves young males. The postwar increase in alcohol consumption in the UK was accompanied by a considerable rise in alcohol-related problems. These, in turn, provided the stimulus for extensive research into various aspects of alcohol use and misuse. This research, in terms of quantity, reached a peak during the 1980s ( Royal College of Psychiatrists 1986; May 1992a). A number of surveys of drinking habits have been carried out in various parts of the UK. These provide an excellent description of the ways in which different subgroups of the population use, or do not use, alcohol. Significantly, they have generally failed to support the well-established and pejorative stereotypes of the drunken Scots and Irish. Studies suggest that people in Northern Ireland are much more likely than their counterparts in Britain ( England, Wales, and Scotland) to be nondrinkers. Over half the women and nearly a third of the men in Northern Ireland are abstainers ( Wilson 1970). In comparison, only 12% of females and 7% of males aged eighteen and over in Britain do not drink alcohol ( Foster et al. 1990). Northern Ireland is very different from Britain in relation to a broad constellation of social attitudes and mores. For example, people in Northern Ireland are far more likely than those in Britain to attend church or to hold a variety of "conservative" views ( Stringer and Robinson 1991). In many ways social attitudes in Northern Ireland appear closer to those of Eire, the Irish Republic (which was established in 1922) than to the rest of the UK ( O'Connor 1978). Even those in Northern Ireland who do drink consume, on average, rather less than do their counterparts in England, Wales, or Scotland ( Wilson 1970). Conventional wisdom has long suggested that the Scots imbibe greater quantities of alcohol than do their English or Welsh counterparts. This image probably owes much to the fact that Scots and Irish have been conspicuous among -293the Skid Row populations in London and other English cities. The image of the drunken Scot has also been popularized by comedians such as Harry Lauder, Billy Connolly, and the contemporary television character Rab C. Nesbitt. A number of surveys have permitted a comparison of the drinking habits of the Scots and their southern neighbors. These have generally failed to confirm the conventional view that heavy drinking is more common in Scotland than in England and Wales. One of the most recent studies ( Foster et al. 1990) indicated that higher levels of alcohol consumption among adult males were most common in the north (Yorkshire, Humberside, the northwest) and the Midlands of England, and in Wales. Among females, the lowest proportions of heavier drinkers were evident in Scotland, East Anglia, and Wales. It is clear that regional variations in alcohol consumption do exist and that these are quite marked ( M. A. Plant and Pirie 1979; Crawford et al. 1984; Breeze 1985a). Even though adult Scots have not emerged from recent surveys as Britain's heaviest

drinkers, two surveys of teenagers have indicated that young Scots are more likely than their English peers to drink less often but to drink more heavily ( Marsh et al. 1986; M. A. Plant and Foster 1991). It is clear from UK survey data that males above the age of seventeen generally consume significantly greater quantities of alcohol than do females. Males are also less likely than females to be nondrinkers. Surveys typically suggest that three-quarters of adult males and around half of adult females in England, Wales, and Scotland drink during most weeks. The corresponding proportions for Northern Ireland are 50% of males and only 8% of females. Typical survey data suggest that British males who drink regularly consume about twenty units; female regular drinkers consume around six or seven units. (A "unit" is equivalent to half a pint of normal-strength beer, cider, lager, or stout; a single glass of wine; or a single bar measure [jigger or shot] of spirits. Each unit is approximately equivalent to 1 cl. or 7.9 g. of absolute alcohol.) There has been considerable attention paid to the use of alcohol by women in the UK (e.g., Camberwell Council on Alcoholism 1980; M. L. Plant 1985; Breeze 1985b). There is no doubt that alcohol consumption by women is far more widespread than it was a few decades ago. Even so, there is no evidence of a recent convergence of the drinking habits of the sexes, Females continue to drink smaller quantities and to drink less often than males ( M. L. Plant 1990). The sexes do, however, differ in their beverage preferences. Females consume only a minority of their alcohol in the form of beer, lager, or cider. Females in Scotland and Northern Ireland are more likely to drink spirits than other forms of alcohol, whereas those in England and Wales are more inclined to drink wines or fortified wines. In contrast, males in all parts of the UK drink around twothirds of their alcohol in the form of beer, lager, stout, and cider. Men in Scotland and Northern Ireland consume a much higher proportion of their alcohol in the form of spirits, notably whisky (as spelled by the Scots). This is not surprising, because scotch whisky is Scotland's most famous export. Males who drink typically do so on three or four days a week, whereas -294females do so on two to three days. Males in Northern Ireland drink on average on two days and females less ( Wilson 1970). There is evidence of a more concentrated drinking style in Scotland and Northern Ireland. This was a major factor motivating the liberalization of Scottish liquor-licensing arrangements in 1976. The change, it was hoped, might ease the pressure to beat the clock by drinking rapidly during the few hours when bars were open. ALCOHOL AND SOCIETY

Alcohol consumption has long been an important aspect of social life in most areas of the UK. The British public house remains a key focus for recreation and leisure activity. Since Roman times taverns, inns, hotels, and other licensed premises have been conspicuous features of the British (and Irish) landscape, and have exhibited many of the virtues and flaws of contemporary society. Most adults in the UK drink at least occasionally. Recent research indicates that although some regional variations do exist in UK drinking habits, vast differences are not evident. As in many countries, drinking repertoires have widened during recent years to include imported drinks such as wines and spirits. Many people may have first encountered some of these while on holiday abroad.

The number of licensed premises (public house, hotels, etc.) in the UK fell from 126,707 in 1926 to 121,931 in 1945. By 1989, the number of such establishments had risen to 199,500. In contrast to the general increase in licensed drinking places in the rest of the UK, the number of such establishments in Northern Ireland (2,999) was lower in 1990 than it had been in 1945 ( Brewers Society 1976, 1991). Drinking, whether at home, in bars, or in restaurants, is normal behavior for most people in the UK. Alcohol, as in many other countries, not only is a beverage but also is widely regarded as a token of celebration and of conviviality. LEARNING TO DRINK

Most children in the UK learn about alcohol at an early age. Alcohol is legal, widely available, and extensively advertised. Most adults drink, so most children are exposed to alcohol consumption in their homes. A considerable minority of young people in Northern Ireland, as well as areas of Scotland such as Glasgow and the Western Isles, are reared in Protestant homes in which alcohol use is disapproved on religious principle. In addition, drinking is commonly discouraged by parents who are Muslim. Most of them reside in urban areas in England, but there are also Muslim communities in other areas of the UK. A classic study of young children's orientations to alcohol was conducted in Glasgow by Jahoda and Cramond ( 1972). This exercise employed a series of gamelike tests to examine what children aged between five and ten years knew and believed about alcohol use. This investigation revealed that even at an early age, most of the children had formed a clear concept that alcoholic drinks were -295distinctive. Approximately 40% of six-year-olds could identify alcoholic drinks by smell, and 60% of ten-year-olds were able to do so. Most of the children were able to connect drunken behavior shown to them in a film with alcohol. The study also indicated that boys were more likely than girls to have been encouraged to drink by their parents or other adults. The authors concluded that as children became older, they developed more negative attitudes to drinking, possibly in response to warnings from authority figures about alcohol misuse. A modified version of the Jahoda and Cramond investigation was conducted by Fossey ( 1994) in Birmingham and Edinburgh. This study confirmed the earlier conclusion that older children in the age group 5-10 have more negative attitudes toward alcohol. In spite of the increase in alcohol use that had occurred since the earlier study, she found a persisting double standard, in that female drinking was viewed more harshly than that by males. Fossey concluded "That alcohol is primarily a male prerogative is a concept that is continually reinforced in British culture" ( 1994, 6). A study of children ten to fourteen years old in the Central Region of Scotland was conducted by Aitken ( 1978). This investigation revealed that the proportion of children who had tried alcohol rose from 62% at ten years of age to 81% at the age of fourteen. Boys were more likely than girls to report earlier use of alcohol. Three-quarters of the children in this study had first consumed alcoholic beverages in their homes. In contrast with the increasing negative attitudes to drinking noted with age among those five to ten years old, the opposite was evident among those ten to fourteen years old. Among the latter, older children reported

less disapproval of drinking. Aitken, like Fossey, noted the existence of sexist attitudes; most children were more disapproving of drinking by girls than by boys. TEENAGE DRINKING

Particular attention has been paid to the use and misuse of alcohol by teenagers. Several reasons explain this concern. First, it is apparent that most "regular" or "serious" drinking begins among this age group. Second, teenage drinking has periodically received widespread attention due to its alleged links with public disorder or other adverse consequences. The mass media in Britain periodically highlight youthful alcohol misuse, often in a sensationalist and distorted way. Such concern has sometimes been justified, even though the role of alcohol in relation to specific offenses is frequently unclear ( Tuck 1989). A Scottish study by Davies and Stacey ( 1972) indicated that most teenagers begin to drink out of curiosity and to be sociable. Moreover, teenagers who drink are often viewed by their peers as more attractive than those who do not drink. Several studies of teenage drinking in Britain have been conducted since the 1970s (e.g., Hawker 1978; M. A. Plant et al. 1985; Marsh et al. 1986; M. A. Plant , Bagnall, and Foster 1990; M. A. Plant, Bagnall, Foster, and Sales 1990; -296M. A. Plant and Foster 1991; Bagnall 1991). These studies show that the great majority of teenagers in Britain drink alcohol. At the age of thirteen only 6-7% of boys and 9-16% of girls have not tasted it. By the age of seventeen, only 3-4% of girls and 4-6% of boys have not done so ( Marsh et al. 1986). By the age of seventeen, approximately 90% of British teenagers are described as drinkers, though the proportion of teenage nondrinkers in Northern Ireland, on the basis of sparse evidence, appears to be higher. Younger teenagers do most of their drinking at home, whereas older teenagers are much more likely to drink with friends and to do so illegally in bars. There is clearly strong social support for alcohol consumption among British teenagers, and a minority of them drink heavily. Most teenagers who drink sometimes experience intoxication or other adverse consequences, such as nausea. Even so, as emphasized by several commentators, the great majority of teenage drinkers normally consume only moderate quantities of alcohol. Available evidence also indicates that during the 1980s alcohol consumption among teenagers and other young adults in Britain did not increase; it may even have declined slightly ( Goddard 1991; May 1992b; Plant and Plant 1992). Many, and probably most, older teenagers drink in bars before the legal age for alcohol purchase (eighteen years). Very few publicans, hoteliers, or bar staff are prosecuted for selling alcohol to minors, a practice that is widely tolerated or ignored. Two studies have monitored the changing drinking habits of study groups of young people from their teenage years into their twenties. Both investigations indicate that there is little continuity between teenage drinking and that of several years later. Even so, the authors of one study concluded that those who drank the most at sixteen were also the heaviest drinkers at the age of twentythree ( M. A. Plant et al. 1985; Ghodsian and Power 1987). Young people who drink most heavily are particularly likely to engage in other risky or health-threatening behaviors. These include smoking, illicit drug use, and unprotected sex

( Plant and Plant 1992). A degree of risk-taking is normal among adolescents from all socioeconomic backgrounds. Even so, those from low-income backgrounds are, in a variety of ways, additionally at risk in relation to ill health, smoking, and illicit drug use. The apparent stability of trends in youthful drinking habits in Britain contrasts with a decrease in tobacco smoking and an increase in illicit drug use among young people ( M. A. Plant 1987; Plant and Plant 1992). CONCLUSION

Drinking has long been an integral part of social life in the UK. The popularity of alcohol is combined with a widespread perception of alcohol misuse as a chronic national problem. In this respect the UK resembles a number of other countries in which popular attitudes toward alcohol are ambivalent. Temperance movements gained considerable influence during the nineteenth century. At that time alcohol consumption was high, and the urban bar was associated, rightly -297or wrongly, with many of the social problems of rapid industrialization. Since World War II, rising alcohol consumption has heightened concern about alcohol misuse. Even so, British attitudes are generally favorable to drinking in itself while disapproving of heavy or problematic drinking. The drinking scene in the UK has undergone marked changes during recent decades. Public bars are now far more congenial and attractive to drinkers of both genders. In addition, British drinking habits have been influenced by the availability of new alcoholic beverages. The British generally enjoy drinking, and recent legislation has attempted to increase the social integration of alcohol use and to discourage alcohol-related problems, but not drinking in itself. 29 An Anthropological View of Alcohol and Culture in International Perspective

Dwight B. Heath The preceding chapters afford a broad view of alcohol and culture in international perspective. In this chapter I will bring an anthropological viewpoint to bear on these data, underscoring some of the similarities that were found and calling attention to some of the more striking differences. In the next and final chapter, I will make some generalizations that combine those national-level data with what we know from anthropological research. A social science approach is one that deals with both uniformity and variation in human experiences, and the meanings of both alcohol and culture can better be appreciated by comparing these accounts, not only among themselves but also with accounts from other cultures throughout the world. COVERAGE OF THIS BOOK

This book is meant to fill an important gap in our understanding of alcohol use and its outcomes throughout the world. Many people know that ethanol is a substance that occurs in nature, without any intervention on the part of human beings. That does not mean it can be understood in the abstract, without a host of meanings, values, and attitudes that give it

cultural context. Even though it is "natural" (rather than "artificial," a distinction nicely articulated in the chapter on China), this does not justify my having written (in Chapter I of this volume) that ethanol is "a relatively simple chemical compound." That is, in itself, an assertion that shows profound cultural bias, implying that there is some positivistic reality out there on which all agree, and that science is the best way of knowing about most of it. Whether one believes that or not, it must be obvious that there are others who do not, and that, at different stages of our own history, knowledgeable and respected people did not believe it. How much -328more does culture influence the ways in which we think about what, where, when, how, and how much to drink; in the company of whom; in what setting; with what utensils; for what purpose; and with what results! But this is not a book about the philosophy of science. It is a social scientist's attempt to derive meaning from contemporary world experience with alcohol and to make it accessible to others. Even an international handbook cannot be encyclopedic in its coverage, but the chapters included here are a remarkably representative sample of nations around the world. Coverage is intentionally diverse. Every continent is represented, as is every latitude. The countries represent nearly 20% of the United Nations, and they included elected and hereditary monarchies, members of commonwealths, federated states, and independent republics, new and old, with a wide range of political and economic systems. Some of the world's largest countries are here, together with some of the smallest. Unlike other volumes that purport to deal with alcohol internationally, this includes developing countries as well as those that have long been at the forefront in terms of urbanization find industrialization. Several other countries would have been of special interest for one reason or another, but could not be included. It is rare to find an authority who is willing and able to write about alcohol, but it is next to impossible to find someone interested in doing it with a cultural emphasis. I was fortunate to be able to draw on colleagues (only one of whom was an anthropologist) for many of whom it was a wholly new way of considering the subject, and they were often a little surprised at what they learned. The nations that are included range from culturally homogeneous ( Denmark, Iceland) to extremely heterogeneous ( Mexico, Zambia), from very restrictive about alcohol ( Canada, Sweden) to unusually permissive ( Italy, Spain), and from unusually high consumption ( France) to extremely low ( Egypt). To be sure, there are some countries that a reader might have wished to be covered in such a volume but that have been omitted for various reasons. For example, Norway's situation is so very close to that of Sweden and Finland that they often enact common laws and conduct joint research; the author for Portugal died before writing even an initial draft; Japanese colleagues were, for a variety of reasons, unable to contribute. Other cases from Central and South America, although unique in some details, would be largely repetitive in terms of general patterns, and the same could be said for much of Africa. Many of the Caribbean and Oceanic nations can be found in the ethnographic literature. It would have been easier to write the book myself, organizing data in a uniform format and producing homogeneous essays that would have allowed quick and easy comparison. But that approach would have conveyed little sense of what knowledgeable people in each country consider important about the subject. I have been a light-handed editor, deliberately choosing

to let each contributing author speak with his or her own voice. To be sure, I gave each chapter a number of close readings, changing many individual words, adding a colloquial translation here and there, reordering some sentences and even mov-329ing a paragraph from time to time in the interests in clearer or smoother communication; English is not the first language for many of these authors. But my editorial revisions were limited to expository style, and never affected content or intent. That is why each chapter tells about different national cultures of drinking, and does so in a distinct manner or voice. The authors come through both as spokespersons familiar with their subject matter and as individuals with their own special interests. At the outset I did ask that each contributor pay some attention to history, to stereotypes and their fit (or lack of fit) with reality, to intranational variation among minority populations, and to recent changes. But I did not prescribe how much or how little should be said about each topic, nor what kind of "spin" to give to the thorny question of alcohol-related problems (if and when they occur) or other aspects of the presentations. That is why there is such variation. Far from being an impediment to the reader's understanding, such variation should help to convey the very real diversity that many people do not fully realize lies at the heart of the scientific enterprise of describing patterns of human belief and behavior transnationally or cross-culturally. Types of Nations

Our sample of twenty-seven nations ranges from the northernmost to southernmost, largest to smallest, densely to sparsely populated, historically dominant to newly emergent, highly developed to minimally, and along many other parameters. Major world areas (such as North Africa, sub-Saharan Africa, Latin America, Southeast Asia, Scandinavia, the Arctic, Oceania) are all represented, and so are a number of religions (Muslim, Jewish, Catholic, Orthodox, Protestant, traditional). Former colonies generally experienced major changes in alcohol use with independence, and most countries still recognize various and important impacts from other nations. Even though the units of analysis are nation-states, where political boundaries are of major importance, it is interesting to note that the contributing authors characterized their countries in different ways. Denmark is seen as intermediate between "the northern countries" and "the south" (of Europe), in cultural orientation as well as in geographic location. The Netherlands is characterized as a "low control" country, signaling a generally liberal view toward individual freedoms in more than the realm of access to alcohol. Types of Cultures

It is a crucial part of the anthropological perspective that boundaries be paid attention to where the local people say that they are important; often such boundaries are not geopolitical so much as ethnic, linguistic, or traditional. Over the years, anthropologists have tended to deal with relatively homogeneous societies, some of them rather small and isolated, and not with nation-states. Out of -330-

that anthropological tradition has grown a preoccupation with understanding holistically as much as possible of the entire culture (or way of life) of a people. I have no intention in this context of discussing in any great detail the more than 200 explicit definitions of "culture" that were cataloged by Kroeber and Kluckhohn ( 1952). In providing brief guidelines to the authors who contributed to this volume, I used my own: "a system of patterns of beliefs and behavior that are familiar to, and, in significant degree, shared by a given population" ( Heath 1986, 234, italicized in the original). Such a way of life, or set of guidelines for understanding and dealing with the world, includes the most prosaic as well as the most exalted aspects of human thought and actions, and is clearly and firmly rooted in local history. As such, it is a useful tool for helping us to understand how and why different populations, often even in the same country, drink very differently and treat both drinking and its results in diverse ways. This approach, recognizing that there may be multiple cultures within a single nation, and that some cultures spill across national boundaries, fits with the general usage in sociology and anthropology, but it differs in some measure from usage that has become commonplace in alcohol studies ( Heath 1984). Often a comparative account of drinking is called "crosscultural" if it deals with two or more countries (where the data ostensibly refer to the country as a whole). Or the same label may be used if a study deals with as few as two different populations that may differ on such varied bases as religion, national ancestry, socioeconomic status (class), ethnicity (race), or other criteria. Many researchers in a broad range of disciplines share the anthropological interest in cultures as both reflecting and shaping behavior, and are even willing to concede that the "patterns of belief and behavior" that comprise a culture constitute a crucial part of the complex whole that determines drinking. In the formulation that calls alcohol use a complex "biopsychosocial" phenomenon (codified by Levin 1990), culture is largely subsumed as part of the social role, with some components being conceded to the psychological. In the formulation that identifies influential factors as the "drug," "set," and "setting" (following Zinberg 1984), culture is often presumed to be a major part of the setting. No one seriously denies the relevance of culture in this connection today, but most observers use the term in a very cavalier manner. The meaning is very close to the formulation of culture when the author describes many component "nations" in China, or different "tribes" in India or Zambia. Similarly, there is a brief mention of different "peoples" in Russia, and in Australia, the Aborigines are treated separately in some detail, as are the Maoris in New Zealand. The Mapuche Indians are culturally distinct in Chile, as are various Indian groups in Honduras and Mexico, and Canadian Natives (Indians) and Inuit (Eskimos) in Canada. These are all populations that have cultures in the anthropological sense, that is, systems of patterns of belief and behavior that are generally shared and agreed upon, or simply ways of life. Any reader who wants to learn in more detail about drinking and its sequelae in such minority populations will find a richly detailed (but very different) corpus of -331anthropological literature scattered through books and journals that do not necessarily have "alcohol" in their titles (guides are Heath 1975, 1987, 1991; Heath and Cooper 1981).

With specific reference to alcohol, it deserves mention that a few sociologists and epidemiologists have used the concept of culture in a very different way, to characterize overarching types of orientation that are international and macroscopic rather than intranational and more microscopic. For example, Poland is described as a "spirit-drinking culture" because distilled beverages are far more popular than fermented ones. By contrast, France, Chile, and Italy are prototypical illustrations of "wine culture," with wine not only the predominant beverage but also an integral part of sociability, hospitality, and so forth, and implying frequent use of wine with meals, by both sexes and all ages, with little drunkenness. Much of Germany is, and Australia was until recently, a "beer culture." In some instances, the contributing authors use terms that may refer to geography or that reflect (for those who are familiar with drinking patterns) transnational similarities, such as "Latin" for France, "Mediterranean" for Italy, "Northern" and "Scandinavian" for Iceland. The authors of the Swedish chapter refer to their being in a "vodka belt" that stretches across northern Europe; presumably this is a convenient characterization of a band of countries where vodka is commonly drunk by groups of men in a context of binges. Similarly, Poland is described as having a "wet culture" (as France, Italy, Spain, and some others might be), with high consumption, liberal attitudes toward drinking, and a relatively low rate of abstention (all of which would be the opposite in a "dry" culture, such as that of Egypt). It is striking that so many of the countries described here have had strong temperance movements at various times, but few have been as long-lasting and pervasive as in Sweden, the United Kingdom, and the United States, all of which fit a criterion of "temperance cultures": having a long history of popular movements that label alcohol a major source of problems ( Room 1992; Levine 1992). Types of Beverages

Most of the analytic studies of alcohol in its various aspects categorize all beverages into three basic types: beer, wine, and spirits. Beers are fermented, usually from a cereal base, and generally contain between 4% and 8% alcohol; also included in this category are mead, ale, stout, and other variants. Wines are also fermented, but usually from a fruit base, and generally contain between 8% and 20% alcohol. Spirits are distilled, and can contain up to 90% alcohol; this category refers to whiskey, rum, gin, brandy, cordials, and any other distillates. Another kind of distinction has to do with manufacture: home brew is a fermented cottageindustry product (sometimes legal and sometimes not), and moonshine is similarly distilled in relatively small batches (usually illegal); there -332is no specific term for wine fermented on such a scale, perhaps because so much of the wine that was taxed and sold widely was, until recent years, handcrafted. It is clear from the individual chapters that lay people do not ordinarily classify drinks this way, and the profusion of individual beverages in different countries is enormous. Grouping all beverages that contain alcohol into these three categories is a convenience for those who put real stock in statistics about average per capita annual consumption, which allows for easy comparison among populations (in countries, states, counties, or other jurisdictions that pay close attention to the sales of such beverages--and most do, because they are a ready

source of tax revenue, and may even be a commercial monopoly of the government). There is little scientific justification for such categorization, as evidenced by the fact that the French decline to consider wine an alcoholic beverage. Nevertheless, in this volume it is convenient to adhere to the tripartite classification, if only to be consistent with the enormous wealth of epidemiological and other literature that deals with alcohol internationally. These statistics have taken on a life of their own (see Appendix). It is also a convenience to be able to refer to such a broad class of beverages rather than always having to list the various forms of fermented beverages and the various forms of distilled beverages--for example, when referring to a historic change in popular taste (as from spirits to beer in Australia in the late 1800s, or from beer to spirits in Iceland and Denmark, and then back again in both countries). In Egypt, a rough rule of thumb identifies beer as an everyday food and beverage, wine as a celebratory drink, and spirits as taboo for religious reasons. The prototypical "wine culture" in Spain and Italy turns out to be little more than a century old, and may be superseded by beer if present trends continue. The Chinese experience is unusual, recognizing "natural alcohol" (made by nonhuman animals) and including mare's milk and a wide variety of flowers as a base for drinks. Cider is mentioned in a region of France, and it is known in some other countries that have apples. Palm wine, mentioned in Nigeria and Zambia, doubtless occurs elsewhere. Stout from an Irish manufacturer is popular in Malaysia, and the distinction between manufactured beers and home brews carries prestige in Zambia. Some authors have tried to characterize their countries in broad terms, but the recognition of significant cultural differences among various regions makes them hesitant. Hence, whereas many writers in other books readily characterize Germany as a "beer culture," our author's focus on culture forces her to admit that one region is a "wine culture" and another favors spirits. Similarly, as important as wine unquestionably is in France, there is a region with a dominant "beer culture" and another where cider predominates. In many of the countries, it is mentioned that different beverages are favored by different segments of the population. Indians and rural peasants in Guatemala, for, example, prefer two illegal categories to the three legal categories that predominate in the cities; manufactured beers are more prestigious than home brews -333wherever they occur; women favor wine where men prefer spirits; Spanish youth prefer beer where their parents favor wine; and so forth. In those few areas of the world where alcoholic beverages were not indigenous, they usually were adopted quickly when outsiders introduced them, and they often became tools of colonial and other economic exploitation. Spirits are often added to a beer or home-brew repertory, but drinks almost never disappear. (The peculiar history of absinthe in France, an interesting exception to that generalization, has yet to be fully documented.) Types of Drinking

One striking feature of drinking in virtually all of the countries in this volume is that it is essentially a social act. The solitary drinker, so dominant an image in relation to alcohol in the United States, is virtually unknown in other countries. The same is true among tribal and peasant societies everywhere.

In many instances, what we would call alcoholic beverages are thought of as food, an integral part of the diet rather than a special substance reserved for special purposes. Such has been the case with beer in Egypt for millennia, and such is the case with wine in France and Italy today. Many different kinds of drinking occur elsewhere: some excitedly celebratory, some solemnly ritualized, some integral to various kinds of work, and so forth. Whether it is by religious practitioners, by jurists or complainants, by suitors or coworkers, the context is always important, as is the participation by key individuals. In many societies, drinking is not even a frequent occurrence, but it can be important on those rare occasions when a binge is not only allowed but imperative. In terms of classifying behavior, just as in terms of recognizing boundaries, an anthropological perspective looks not so much to impose any set of standards from the outside as to understand how things are viewed from the inside. Thus it is crucial that we recognize typologies of drinking that are pertinent in the ways of thinking of different peoples but that may never before have been mentioned in the analytic literature about alcohol. For example, we are told of different types of drinking (religious, medical, recreational, and other) in China; "wrong" and "normal" consumption in Denmark; "celebratory," "ritual," and "social" drinking in Honduras; "traditional" and "nontraditional" in India; and "proper ways," as well as very different (but locally appropriate) times, for drinking in Spain. For any effort to understand not only the uses of alcohol but also the consequences of such use, it is crucial not only to understand how much a person drinks on one occasion but also how frequent such occasions may be. Chronic drinking without food can damage one's liver and other organs; if alcohol is taken with food, there is less likelihood of pathology. Episodic binge drinking carries virtually no such risk but may pose other risks (such as accidents). Because of these variant modes of quantity per occasion, similar per capita consumption figures can reflect very different customs and usages. -334A few specific patterns that recur in different countries should perhaps be mentioned. The pattern of drinking in which a group of men take turns paying for drinks for everyone in the group--buying rounds in the UK, or "shouting" in Australia--not only has social and economic implications, but also implies that men more often stay longer in a bar and drink more than they would if they were paying just for their own drinks. The idea of offering drinks to friends and neighbors who join in a cooperative work effort (raising a building, taking in the harvest, or other reciprocal labor) assures the availability of labor at crucial times, and makes a pleasant social occasion of what otherwise might be drudgery. It is interesting that urban Zambian women are developing a genderspecific pattern of drinking in informal "kitchen parties" very similar to those in Sweden. THEORIES ABOUT DRINKING

The emphasis in this book is more descriptive than analytic, and most of the authors felt constrained by space limitations. There are a host of theories about alcohol and its use, emphasizing a host of different variables depending on the disciplinary orientation of the theorist. For a remarkably thorough and concise view--including genetic, neurobiological, neurobehavioral, psychoanalytic, personality, conditioning, learning, systems, availability, anthropology, and economic tendencies, see Chaudron and Wilkinson ( 1988).

Nevertheless, a few points deserve to be mentioned in setting these chapters into the context of the existing literature. For example, it is refreshing that so few of the authors made much of the ever-popular but simplistic notion that the primary reason people drink alcohol is to reduce tension or to relieve stress. Undoubtedly, it is one component among the motivations of many drinkers, but it is hardly informative when we try to understand similarities and differences at the cultural level among such diverse populations in such diverse situations. The authors of these chapters are generally familiar with theories about drinking, and many have made substantive contributions. Without belaboring such points in detail, it is interesting to note some special features of theoretical importance in this book. In its reference to dietary status, the typology of drinkers that is described in some detail in Chile differs from that used in other parts of the world. Inasmuch as Chile long served as the model for epidemiological studies of alcohol throughout Latin America, it will be interesting to see whether this typology gains broader acceptance. In writing about Italian social thought, we are confronted with the absurdity (which often occurs elsewhere) that for political purposes, alcohol is often linked with crime and poverty in a causal manner--and vice versa. The five "sets of reaons for drinking" that are given for Russia may well be unique to the political and economic situation of that country. A personal sense of guilt is mentioned as a primary part of various alcohol-related problems only in Iceland, -335which has an exceptionally high rate of problem drinking with a low rate of consumption. This inverse relationship runs counter to the predictions of the World Health Organization and many authorities, although it is by no means unique. France, Italy, and Spain all have unusually high consumption and low problems; it is even suggested here that in France, problems appear to be inversely correlated with both the quantity and the frequency of drinking. For some years I have been making this same point with reference to many of the populations that have been studied by anthropologists, as will be discussed in the concluding chapter. ALCOHOL IN RELATION TO OTHER ASPECTS OF CULTURE

Duster ( 1983, 326) put it nicely: "Alcohol is to social science what dye is to microscopy. . . . What this dye does is to show up certain kinds of fundamental features of the structures of the cell, and I suppose that we can probably use alcohol the same way to penetrate the structure of social life." Using much the same logic, I have suggested that quite apart from the intrinsic interest the subject of alcohol may hold, it should be of interest to any social scientist inasmuch as it affords a sort of window into other aspects of culture. In a series of review articles that trace the evolution of anthropological writing about alcohol ( Heath 1975, 1987, 1991), I have shown how various categories that are of theoretic and other interest are illuminated by studies of drinking in sociocultural context, whether the authors intended them to serve such purposes or not. In this section, it seems appropriate to help the reader appreciate the degree to which alcohol affects other aspects of culture. In a broader sense, this discussion may dramatically illustrate the degree to which the various aspects of any culture are inextricably linked to each other,

whether the integration is smooth and trouble-free or the opposite. There can be few more important points to be made in terms of understanding the concept of culture and its importance in human behavior. Social Organization

Fundamental to any society that has a culture is social organization. Without it, no one could know who's who, who should be doing what (and who should not), who should be where (and who not), and so forth. It includes not only the identification of individuals but also their grouping into categories (by age, sex, kinship, class, occupation, or any of a variety of other criteria that may be socially relevant in a given connection). We have already mentioned the striking fact that drinking is primarily--and almost exclusively, in these countries--a social act, sometimes shared by a family with a meal, sometimes with coworkers, sometimes other men (or women), -336or otherwise used as a basis for inclusion or exclusion. To illustrate the specific ways in which alcohol provides insight into social organization, consider these examples from the preceding chapters. Many authors said, in so many words, that "group drinking reinforces group cohesion" ( Chile), "drinking together helps to integrate family and friends" ( Poland), or "promotes social solidarity" ( Spain). In both Australia and the UK, "mateship" (male bonding or friendship) is implied by drinking, much as female friends and neighbors bond during "kitchen parties" with drinking in Sweden and Zambia. "Social credit" is explicitly mentioned among Australian Aborigines, and it is implied in many other contexts, whereby even people who have little money can confirm ongoing networks of reciprocity by occasionally sharing a few drinks. Gender

One measure of status that is recognized everywhere is gender (what many consider to be the sociocultural implications of the biological category of sex differentiation). Repeatedly our authors make the point that men drink more, and more often, than do women. (This is almost a cultural universal with only two peculiar instances--both small migrant groups in novel settings--known where the opposite holds [ Heath 1993].) In many groups, drinking together is an important way men act out their stereotypes of masculinity with boisterous behavior, frequent expressions of aggression, boasting about their capacities for drink and sex, and otherwise underscoring exaggerated caricatures, as in the "kiwi bloke" of New Zealand or the "macho" of Mexico or Chile. The settings in which such male demonstrative drinking takes place are often segregated to keep women away ( Germany, Sweden), and youths are often eager to "prove their manhood" by drinking conspicuously ( Italy, UK). In the wine cultures around the Mediterranean, men often drink together without drunkenness, whereas in the beer- or spirits-drinking cultures to the north, they drink especially to get drunk. Associated with this difference is the cultural view in the south that

men are responsible for social order, and hence they would be shamed by any breach of it; by contrast, in the north it is women who are expected to assure moderation and propriety. In Scandinavia, it is often expressly said that women oversee or control men's drinking (which is why binges usually occur away from women). Such imposed control is hardly necessary when a man's own honor is at stake, as is the case in the Mediterranean or Latin America. A double standard often applies to the morality of drunkenness, with it expected of males but deplored among females. Associated with this is the frequent presumption that a woman who drinks in the company of men is sexually promiscuous and otherwise immoral. In France it is thought that men need wine, whereas women do not. A meal without wine may not be considered fit for a man, but it is commonplace for women to abstain or to drink different beverages -337(sometimes sweeter and usually with less alcohol). In Guatemala there are a few specific ritual occasions during which female drunkenness is not only accepted but actively sought as a form of spiritual transcendence. Sweden and Zambia recognize the "kitchen party" as an occasion on which drinking by women is a standard form of sociability, but it is clearly in a private setting with no men present. Most countries report that women are drinking more than they used to, and more frequently, but not significantly so and not in ways that result in problems. Historically, it appears that drinking by women becomes a focus of public attention when they claim increased status, wealth, or other power. The epidemic of problem drinking that many predicted as women challenged traditional limitations (and supposedly suffered more stress through competing with men) in various countries did not materialize, dashing many superficial stereotypes about both feminist liberation and use of alcohol. An interesting countertrend is that most countries report men are drinking somewhat less, and less often, than in the 1980s. Such short-term changes, unless they are dramatic in scale or are linked with major increases or decreases in the rate of various important linked problems, are difficult to interpret, but collectively they make it obvious that gender significantly affects drinking. Arguments can be made to the effect that women get the same impact from using less alcohol. This is true, partly because they tend to weigh less than men, partly because they have proportionally more fat and less muscle (so that alcohol is diffused through their bodies in less water), and partly because females have less of an enzyme that metabolizes alcohol, so it stays in their bodies longer. But none of these physiological data were known a generation ago, so we must again recognize how potent social organization is in shaping drinking customs. For interesting cultural studies that focus on female drinking, see Gefou- Madianou ( 1992) and McDonald ( 1994). Age

Another criterion of social organization that is culturally significant is age. Although cultures may emphasize different ages in different ways and demand varying kinds of behavior, all recognize developmental stages and allot rights, privileges, obligations, and expectations on the basis of them. The ways in which age relates to drinking are many and diverse, although some patterns can be discerned.

One trend that appears to be widespread is that people are beginning to drink at an earlier age, and that young people are drinking more than they used to (e.g., Iceland, Mexico). Most of the contributors to this volume mention survey data that point in this direction, although the content, context, meanings, and outcomes of young people's drinking continue to be very different. Although I have no reason to question the data, they may be similar to those about women--an increase that is more apparent than real at a time when young people are testing the limits of their restricted status and power. In Spain, youth -338not only drink different beverages but also drink in different ways, and they drink for the effects (which few elders do). The idea of a minimum age before children should be "protected" from alcohol is alien in China and France; where it is a matter of law, the mid or late teens are favored. Young students are said to have increasing alcohol problems in Nigeria and Iceland; adolescent drinking is interpreted as part of a youthful rebellion in Israel and Sri Lanka. Despite sensationalized accounts in the media, preadolescents in the UK are aware of alcohol but are not frequent or heavy drinkers. Children learn to drink early in Zambia by taking small quantities when they are sent to buy beer; children in France, Italy, and Spain are routinely given wine as part of a meal or celebration. Alcohol plays an important part in various rituals of the aged in China. Drinking is stratified by age in Zambia, with new taverns appearing now that young men have greater access to money, and thus to beer. All in all, the international data confirm the anthropological cross-cultural data in showing that the attitudinal context, rather than the beverage, shapes expectations and actions with respect to alcohol as it relates to age, just as it relates to other aspects of culture. Class, Caste, and Other Categories

A third aspect of social organization that tends to be important in most cultures is stratification, whether by class, caste, or other hierarchical ranking (such as schooling, income, occupation, religion, etc). Whereas Denmark prides itself on class equality, most of the countries admit to having very different drinking patterns in different socioeconomic classes. Fairly elaborate differences are spelled out in Malaysia and Spain, and the use of alcohol at all is an important status marker in religiously heterogeneous Sri Lanka. In India, where caste is important in many levels of human activity, alcohol is one of the few things to which the lower castes enjoy more access; the same is true in Sri Lanka. By contrast, in Guatemala, Indians may use home brew as ladinos use beer, with the emulation described as if it might facilitate social mobility. In Zambia, beer is the drink for most, but those who have achieved or aspire to upward mobility often shift to spirits as a sort of emblem. In many countries, even religions are hierarchically ranked. Roman Catholicism incorporates wine into its sacraments and appears rarely to have been associated with major pronouncements against alcohol. By contrast, several Protestant sects hold to abstinence as an article of faith and denounce drinking as evil ( Sweden, Iceland); Muslims do the same ( Egypt, Malaysia). This, combined with vigorous missionary activity, has resulted in conversion by many who want to escape the social obligation to drink and to spend heavily in some countries that have traditionally been Catholic (e.g., Guatemala, Honduras). It is interesting to note that Buddhism, Hinduism, and Confucianism are not so ascetic as many

believe ( China, India), and that there is little difference in drinking between the few people who drink in Egypt, whether they are Christian or Muslim. -339Economics and Politics

Whatever else they may be, alcoholic beverages have become economic commodities that have played many different roles throughout history. In Russia and Poland, our authors emphasize their early and continuing manipulation to the economic and political advantage of a few; state monopoly of sale is still common ( Canada, Egypt, Sweden), and heavy taxation prompts police to try to suppress home-brewing and moonshining ( Guatemala, Nigeria). In France, Italy, Spain, and New Zealand, wine is an major export important to the national economy, as spirits are to Scotland ( UK). In Malaysia, as in much of the developing world, breweries are viewed as an important symbol of economic development, just as the right to drink was involved with the movement toward political independence (in very different ways in India, Poland, and Zambia). Some minority populations still suffer restrictions similar to those that pertained during the colonial period: Aborigines in Australia, Mapuche Indians in Chile, Black natives in Zambia, and others. The economic value of alcohol as a tool in colonization is firmly imbedded in the "firewater" myth ( Canada and the United States), and its use in maintaining debt peonage among peasants is similar in Denmark, Guatemala, Sweden, and elsewhere. The political importance of alcohol in a few countries is implied by its being mentioned in the constitution ( Honduras, India), or in major amendments to it ( United States), although the Indian and U.S. experiments with total national prohibition both failed, as did most other such experiments in history. The pub as a center of political activity made it subject to regulation in both Germany and Italy, just as coffeehouses and chocolate shops were suspect at different times and places. The costs of drinking are one of the major sources of friction within some households, although the "social credit" that is built up thereby is not usually weighed in evaluating it. As beer and legally distilled spirits replace home brew and moonshine in Guatemalan ceremonial drinking, money that had been redistributed within the community is being siphoned off to outsiders. Furthermore, the role of alcohol in political rituals ( China, Guatemala) is similar to what is found in many peasant and tribal societies. Here is another respect in which the international data conform--not in specific detail but in general pattern--with those described by anthropologists in small societies throughout the world. Interethnic Relations

To say that different ethnic populations have different patterns of belief and behavior with respect to alcohol is to imply that in many instances, drinking itself can be an important boundary marker between social groups. This is dramatically emphasized in countries as diverse as Australia, Canada, Guatemala, Malaysia, Mexico, New Zealand, and Sri Lanka. The various populations may be called "nationalities" (as in China), "ethnic minorities" ( Malaysia), or "re-340-

ligions" ( Zambia, Sri Lanka), but it is clear that the way people drink (or don't drink) marks them as belonging in different social categories. Differential laws about the availability of alcoholic beverages have done much to aggravate ethnic tensions in Australia, Zambia, and elsewhere, including, at various times, attempts to impose prohibition on native people ( Canada, New Zealand). The use of certain beverages (home-brewed palm wine, moonshine) may delineate one group from another ( Honduras, Nigeria, India), in which case changing one's drinking pattern may be seen as a way of increasing one's social status. In Russia, it is suggested that acculturative stress is one of the factors that lead to heavy drinking among members of minorities; most other countries where there are significantly disadvantaged populations could probably say the same. As Third and Fourth World populations become increasingly involved with the capitalist economy and with manufactured beverages, this is a frequent (but not universal) trend. International Relations

Partly because of its economic value and partly because of evangelical views of morality, alcohol has long been subject to a variety of international policies and controls, and international differences are becoming increasingly important as trading blocs proliferate, threatening protective tariffs, introducing easier access to foreign goods, and so forth. Former colonies Australia, Canada, India, and New Zealand all show vestiges of domination by the UK. Denmark shows in microcosm how wars affect trade, diet, and manufacturing, and it is striking that the sale of the Virgin Islands saw a virtual end to the popularity of rum as a beverage. Tourists are credited--or blamed--for introducing new drinking patterns in such different countries as Iceland and Spain. Participation in both World Wars is cited as having introduced many volunteers from India to drinking on European models. Historically, the broad distribution of grape-growing in Europe is largely a heritage of the Roman Empire, just as wine production in Latin America was deliberately introduced by the Spaniards. A few areas that had not had indigenous alcoholic beverages received them from European traders and often adopted them with alacrity ( Canada, Malaysia, New Zealand). In regions where native drinks had long been used, the newly introduced beverages were generally added to the drinking repertory rather than displacing the old. The historical account of Nigeria includes the discussion of ambitious international efforts to restrict the alcohol trade-and, with it, slavery--throughout sub-Saharan Africa near the beginning of the twentieth century. Large-scale recent international efforts tend to follow the general guidelines that the World Health Organization has offered for national policies: restricting sales, indexing prices, increasing taxes, regulating advertising, and in various other ways limiting the availability of alcohol ( Grant 1985). Such efforts at increasing controls are explicitly rationalized and recommended on the premise that alcohol-related problems occur in proportion to per capita consumption, a theory -341that we have disproved at least in France, Italy, Spain, Iceland, and Sweden, as well as in several ethnographic studies elsewhere. Diet and Nutrition

As our Russian contributor reminds us, ethanol is endogenous to the human body, not an alien substance. Nevertheless, the habitual use of any beverage affects diet, nutrition, and

ultimately health of those who use it. Among "tribals" in India, Mexico, and Nigeria, for example, the various home brews are generally recognized--by scientists as well as by the drinkers--as foods that provide a wide range of vitamins, minerals, and other nutrients that are beneficial. In a similar manner, the populations of France, Italy, and Spain have long looked on wine as being healthful, and scientists in recent years have found increasing justification for that view ( Ford 1993; Ellison 1993). Apart from vitamins and minerals, there are flavonoids that favorably affect cholesterol levels, thereby diminishing the likelihood of atherosclerosis and other coronary heart disease (the major cause of death in significant portions of the population). Anti-oxidants are other beneficial components of wine that justify its inclusion daily in the "Mediterranean diet" recommended by the Harvard School of Public Health, the WHO Regional Office for Europe, and the Oldways Preservation Trust ( Oldways 1994). The French go so far as to consider wine a necessary component of "a good meal," and regard it as "the sanitary beverage," quite distinct from what they consider to be alcohol. Even commercially manufactured ferments are sometimes thought to be nutritious. The commercial slogan "Guinness [brand of stout] is good for you" has apparently been incorporated into the folk wisdom of much of Malaysia, and our author says it was not long ago that ale was "more healthful than milk or water" in the UK. When too many food crops are distilled, as happened historically in Denmark, significant health problems can result. Land that is given over to growing crops for the production of alcoholic beverages is often taken out of service for producing local food crops, so that macroscopic economic factors can interfere with diet. The same can happen microscopically if too much of a household's income is diverted from food to drink. Another side to this coin is that for women (who usually are the producers of cottage-industry alcohol) it is a source of income that would not otherwise be available to them, and it is often spent on food or schooling for their children, benefiting not only them but also their communities. The way in which alcohol is drunk can also affect diet and nutrition; in both China and Denmark, distilled beverages are treated as an adjunct to food, so they have very different effects than when they are drunk without food. Language, Literature, and Folklore

Any cultural trait that has been the focus of as much attention as alcohol consumption will invariably be reflected in the language, literature, and folklore of a people. The Chinese credit monkeys with having discovered fermentation -342and tell stories about specific individuals (in different regions) who are culture heroes for having introduced people to alcohol. Egyptians tell of the god Osiris bringing beer to them, just as the Romans (of ancient Italy) credited the god Bacchus with having introduced wine, and the ancient Mexicans thought pulque was a gift from the gods. Drinking has played an important role in the arts, both visual ( Egypt, Italy) and poetic ( China, France, India). Drinking and drunkenness were important aspects of the legendary prowess of the ancient Vikings ( Denmark). The vocabularies, proverbs, folktales, humor, and other realms of popular culture in China, Denmark, Poland, Italy, Spain, and Sweden are full of allusions to drinking, mostly favorable, and the concept of ivresse has special meaning in French thought, combining drunken intoxication with rapture and ecstasy. The symbolism of toasting is widespread as an important--and sometimes mandatory--component of sociability, often constituting a form of folk art in itself. Much of what is learned about drinking, whether

favorable or unfavorable, is passed from one generation to another through stories, songs, poems, tales, and sayings that reflect long-term cultural experiences and attitudes. Conflict Management and Law

Few commodities are subject to as many laws and regulations, in as many countries, as are beverages containing alcohol. Most of the authors have taken pains to show how such controls have changed over time and how they currently affect alcohol use and outcomes. Laws about who may drink what and where ostensibly have to do with preserving public order, although it is not clear whether the resentment they engender may not often be more problematic than would be allowing, for example, members of different ethnic groups to drink together ( India, Zambia). At any rate, it is evident that such official or formal controls are far less effective in shaping behavior than are the unofficial informal controls that people exert in their daily interactions, through gossip, exhortations, or other forms of social sanction. In one sense, this is the essence of culture as a system that makes it possible for us to live with others without frequent and insuperable conflicts. When conflicts do arise, all societies have prescribed ways of dealing with them, even when there is no specific police force or written body of laws. One example is that of the Mapuche Indians in Chile, for whom an interesting sidelight is that the formerly competing parties at a hearing before the elders share a drink to symbolize their satisfaction at the end of deliberations. Such a pattern also exists among many tribal peoples in Africa. Similar drinking to "seal a bargain" is reported as an integral part of trading among some tribal societies in Africa. Religion and Ritual

The reality, magnitude, and emotional significance of differences among cultures is vividly displayed in contrasting views that people hold concerning al-343cohol and religion. Some consider it a gift of the gods, and others use it as a sacrament ( China, India, Russia, Spain). Whereas some view alcohol as evil ( Denmark, Iceland, many Protestant Christians throughout Latin America and Africa, Muslims anywhere), others consider it so holy that it is an ideal offering to deities or spirits of ancestors ( China, India, Zambia). Drunkenness is often viewed as a religious experience, so that this shortcut to revelation is not only allowed but also approved on special occasions (even for women in Guatemala). It may surprise some readers that there is little difference between Muslim and Christian drinkers in modern Egypt. By contrast, Israel sees striking differences among different sects within Judaism. The long history of appreciation of alcohol among Muslims is noted in Spain; Muslims are now trying to enforce prohibition among others as well as themselves in Malaysia. Religious differences can be discerned even in countries that superficially appear to be relatively homogeneous in terms of ethnicity, such as Germany and the Netherlands. Protestant abstinence appears to provide an alternative for some Latin Americans who want to opt out of the costly and time-consuming civilreligious hierarchy of community governance in which even secular rituals often involve heavy drinking and drunkenness. Some populations in China view drinking as necessary "to keep the world in balance," and

some Zambians treat home brew as a sacred combination of key cultural factors--the household (hearth) and the field (grain)--brought together by women. Nevertheless, there are many others elsewhere who consider any alcohol an abomination. This is among the more dramatic and emotionally loaded respects in which alcohol and culture relate to each other, and it is by no means merely an archaic concern among people who know little about the rest of the world. Health and Curing

In most modern nations, the rationale that state authorities give for trying to restrict the availability of alcohol, even though it is a legal substance, is public health. It is ironic that at a time when the abundant evidence that the prophylactic effects of alcohol on blood vessels is rapidly mounting, there is strong institutional hesitancy to endorse regular consumption. By contrast, until the twentieth century, alcohol held a fundamental place in the pharmacopoeia of most cultures, and it is still credited with a variety of preventive and curative effects. In France and Italy, "wine builds the blood" and is thought to be positively healthful in many other respects. In Malaysia, "Guinness is good for you" because it supposedly maintains the balance of humors between "heaty" and "cooling." Tribal populations in China, India, and Nigeria specifically use alcohol as medicine and as an integral part of curing rites. Conversely, heavy drinking (especially over a long time) is generally thought to be harmful. Nigerians recognize alcohol poisoning as a problem in children; the French and Italians are aware that a portion of their high rates of cirrhosis is probably due to alcohol; and many of the statistics that purport to relate to -344problem drinking are specific to health (admissions to hospitals, certain cancers, etc.). As is so often the case, the same substance is both embraced and reviled for its role in relation to physical well-being, underscoring how important cultural context is in the evaluation of an act that may look similar but that has very different meanings and impacts in different populations. Continuity and Change

Just as is the case with every other aspect of culture, beliefs and behaviors about alcohol are characterized sometimes by remarkable continuity and sometimes by rapid change. One of the most abrupt changes in many parts of the world was the introduction of new beverages (especially distilled spirits) to societies that had not known indigenous alcohol. Several of the authors writing about former colonies have described how alcohol was used in early trade or in markedly unequal kind of employment to take advantage of native populations ( Australia, Canada, Guatemala, Nigeria, Zambia), or as a way of keeping lowerclass workers in debt bondage ( Denmark, Russia, Sweden). It is claimed that there has been little change in drinking in Egypt during 4,000 years except for the impact of Islamization. By contrast, the "gin epidemic" looms in English history as an important by-product of urbanization and industrialization, and many other countries point to these same processes as triggering major changes ( Germany, Poland, Spain). Just as urbanization often crowds strangers together in a different and alien ambience, so industrialization separates the workplace from the home and creates a new distinction between work and leisure. In some countries, the history of the

"wine culture" is more shallow than most readers would expect, with the prototypical French proletarian pattern only about 100 years old, prior to which wine was a luxury for the rich. With few exceptions, populations appear to be drinking less now than they did in the 1970s, and the impact of such currents as tourism, the international youth culture, women's liberation, and growing common markets can be great on traditional drinking patterns. Shifts in popular preference for different beverages occur: from beer to spirits and back to beer in Denmark. Rapid changes in attitudes toward alcohol have occurred for largely political reasons in Germany, Poland, and Russia, and ideas about social mobility and the symbolism of drinking have affected practices in countries as different as Guatemala, India, Malaysia, and Zambia. Even the high occurrence of HIV/AIDS is reflected-for instance, in Zambia, where it interferes with peasants' production of home brew. Movements ostensibly to inculcate temperance (but often aimed at achieving prohibition) have been remarkably widespread since the 1700s. Earlier prohibitions occurred in China, Russia, and elsewhere, but tended to be short-lived, disappearing with the monarch who decreed them. Movements with significant popular support are mentioned in most of the European countries, as well as in Australia, Canada, Iceland, and India; and sometimes they resulted in large-scale -345prohibition ( Canada, Iceland, India, the United States) or in rationing ( Sweden). It seems ironic that Iceland banned beer for several years while spirits were still legal, whereas most countries have generally been more restrictive of higherproof drinks. The religious component of most temperance movements should not keep us from looking for other motives ( Gusfield 1986), and the recurrent failure of most prohibitions should serve as a warning against relying on strict governmental controls to regulate drinking and other popular behavior. REFERENCES

Chaudron C. Douglas, and Adrian Wilkinson (Eds.). 1988. Theories on Alcoholism. Toronto: Addiction Research Foundation. Duster Troy. 1983. Commentary. Pp. 326-330 in R. Room and G. Collins (Eds.). Alcohol and Disinhibition: Nature and Meaning of the Link. NIAAA Research Monograph 12. Rockville, Md.: National Institute on Alcohol Abuse and Alcoholism. Ellison R. Curtis. 1993. Does Moderate Alcohol Consumption Prolong Life? 2nd ed. New York: Americal Council on Science and Health. Ford Gene. 1993. The French Paradox and Drinking for Health. San Francisco: Wine Appreciation Guild. Gefou-Madianou Dimitra (Ed.). 1992. Alcohol, Gender, and Culture. London: Routledge. Grant Marcus (Ed.). 1985. Alcohol Policies. Copenhagen: World Health Organization, Regional Office for Europe.

Gusfield Joseph. 1986. Symbolic Crusade: Status Politics and the American Temperance Movement. 2nd ed. Urbana: University of Illinois Press. Heath Dwight B. 1975. "A critical review of anthropological studies of alcohol use". Pp. 1-92 in R. J. Gibbons, Y. Israel, H. Kalant, R. Popham, W. Schmidt, and R. Smart (Eds.). Research in Alcohol and Drug Problems. Vol. 2. New York: John Wiley and Sons. -----. 1984. "Cross-cultural studies of alcohol use". Pp. 405-415 in Marc Galanter (Ed.). Recent Developments in Alcoholism Vol. 2. New York: Plenum. -----. 1986. "Concluding remarks". Pp. 234-237 in T. F. Babor (Ed.). Alcohol and Culture: Comparative Perspectives from Europe and America. Annals of the New York Academy of Sciences 472. New York: NYAS. -----. 1987. "A decade of development in the anthropological study of alcohol use: 19701980". Pp. 16-69 in Mary Douglas (Ed.). Constructive Drinking: Perspectives on Drink from Anthropology. Cambridge: Cambridge University Press. -----. 1991. "The mutual relevance of anthropological and sociological perspectives in alcohol studies". Pp. 125-143 in Paul M. Roman (Ed.). Alcohol: The Development of Sociological Perspectives on Use and Abuse. New Brunswick, N.J.: Rutgers Center of Alcohol Studies. -----. 1993. "Cross-cultural perspectives on women and alcohol". Pp. 100-117 in E. S. L. Gomberg and T. D. Nirenberg (Eds.). Women and Substance Abuse. Norwood, N.J.: Ablex. Heath Dwight B., and A. M. Cooper. 1981. Alcohol Use and World Cultures: A Comprehensive Bibliography of anthropological Sources. Bibliographic Series 15. Toronto: Addiction Research Foundation. -346Kroeber A. L., and Clyde K. M. Kluckhohn. 1952. Culture: A Critical Review of Concepts and Definitions. Papers of the Peabody Museum of American Archaeology and Ethnology 47 (1). Cambridge, Mass.: Peabody Museum of Harvard University. Levin Jerome D. 1990. Alcoholism: A Biopsychosocial Approach. New York: Hemisphere Publishing. Levine Harry G. 1992. "Temperance cultures: Alcohol as problem in Nordic and Englishspeaking cultures". Pp. 16-36 in M. Lender and G. Edwards (Eds.). The Nature of Alcohol and Drug-Related Problems. Oxford: Oxford University Press. McDonald Maryon (Ed.). 1994. Gender, Drink, and Drugs. Oxford: Berg Publishers. Oldways Preservation and Exchange Trust. 1994. International Conference on the Diets of the Mediterranean. Boston: Oldways. Pernanen Kai. 1991. Alcohol in Human Violence. New York: Guilford Press.

Room Robin. 1992. "The impossible dream? Routes to reducing alcohol problems in a temperate culture". Journal of Substance Abuse 4:91-106. Zinberg Norman E. 1984. Drug, Set, and Setting: The Basis for Controlled Intoxicant Use. New Haven: Yale University Press. -34730 Some Generalizations about Alcohol and Culture

Dwight B. Heath The varied sample of national experiences with alcohol that are described in this book prove again how diverse the cultural reactions to a substance can be, yet it also shows commonalities among the detailed differences. From an anthropological perspective, it was important to show the many and diverse ways in which drinking articulates with various other aspects of culture, such as social organization, economics and politics, interethnic and international relations, diet and nutrition, language and folklore, conflict management, religion and ritual, health and curing, and continuity and change. However, from the broader social science perspective, it is important also to highlight some generalizations that can be made about drinking and its outcomes, without repeating many of the close linkages between alcohol and culture that were emphasized earlier. ABSTINENCE, TEMPERANCE, AND AMBIVALENCE

Those who are new to the field of alcohol studies are often surprised to find out how many people do not drink at all. In the United States, this is more than one-third of the adult population, up from the 1980s. Abstainers (defined as those who drink no more than once a year) are thus a substantial segment of the population who should be taken into account when one tries to evaluate such figures as per capita consumption, the proportion of drinkers who have problems with drinking (about 10% in the United States), and so forth. For some, abstinence is a matter of religious faith; for others, a matter of personal taste, a resolution to maintain one's distance from alcohol in order to maintain one's sobriety, or some other reason. An unusually high percentage of Australian Aborigines abstain; the same is true of Egyptians, Indians, Irish, Lutheran Icelanders, and fundamentalist Protestants wherever they may be. Although drink-348ing and drunkenness have long been popular in Germany, some famous men have spoken out forcefully in favor of greater moderation there. "Moderation" and "temperance" are buzzwords in relation to alcohol that have very different meanings in different contexts. "Moderation" or "moderate drinking" differs in terms of quantity and frequency, depending on cultural context (e.g., Chile's idiosyncratic terminology allows for much more drinking than does that in Egypt or India, where drinking at all is out of the ordinary), but the latest scientific advice is that one to two drinks a day constitutes an appropriate part of a healthful diet for most persons ( Ellison 1993). "Temperance" would appear to mean much the same as "moderation," but historically it has most often been used

by those who deplore drinking and would curtail it if they could. Although their aim is usually prohibition, most temperance advocates have, during the twentieth century, generally recognized that the frequent rapid repeal of prohibition demonstrates popular opposition to such forceful involvement of the state with respect to a habit that many enjoy--and consider beneficial for a variety of reasons--so, tactfully, they are now speaking out for gradual rather than abrupt restriction of drinking. This is not just the paranoiac projection of a libertarian moderate drinker who does not want to be told by others that he has to quit. Although few people who are not engaged in the study of alcohol are aware of it, both the World Health Organization ( 1981, 1992) and the U.S. Department of Health and Human Services ( 1991) have made official pronouncements calling for a 25% reduction in overall alcohol consumption. This is only the most recent of many temperance movements. In the early 1800s, Canada, the UK, and the Netherlands joined the United States in strongly religious temperance movements. By the mid-1800s, Poland and Russia had their own such movements, and nearly half of the states in the United States had enacted local prohibition. By the late 1800s, those U.S. prohibitions had generally been repealed, but a strong wave of temperance sentiment swept over Australia, Sweden, and flourished again in Netherlands and the United States. In the early 1900s a temperance movement unexpectedly arose in Italy, and that in the United States gained momentum, culminating in nationwide prohibition (18th Amendment of the Constitution) in 1919, repeated by the 21st Amendment in 1933. Mexico, where one might not have foreseen a prohibition movement, had a brief one in the 1940s, and France had one in the 1960s. A "New Temperance Movement" has been influential not only in the United States but also throughout much of the world since the 1970s ( Heath 1989; Pittman 1991). At first couched in religious or moralistic terms, the rhetoric has shifted toward science and pseudoscience, sometimes even distancing itself from religion and emphasizing public health, economics, or social welfare to appeal to new and broader constituencies. In India, Poland, and Sri Lanka--all in different ways-temperance was linked with anticolonialism and the push toward independence. Abstaining was never popular in Denmark, but the local category of "wrong consumption" shows that there is a fundamental ethic of moderation. -349In the few countries where social historians have paid attention to temperance movements, there appear to be cycles of waxing and waning enthusiasm ( Musto 1987; Blocker 1990) that are reflected in "long waves of consumption" ( Skog 1986) and may be related to the ambivalence that many people hold with respect to alcohol, viewing it as both a boon and a bane, enjoyable but potentially dangerous. The frequently ambivalent reaction to alcohol accounts for much of the confusion that young people have about it and for many of the discontinuities that are reported in the histories of the nations described here. A sociologically sophisticated discussion of such ambivalence as an important portion of the human experience of alcohol is Room ( 1976). BENEFITS OF MODERATE DRINKING

In light of the negative evaluation of alcohol and drinking in many of the scientific and popular writings about them, stressing disease, death, and other costs to the individual and to society, it is remarkable that the attitudes, usages, proverbs, and experiences of the vast majority of the people and peoples dealt with in this book are positive. There are few cultures

in which the dangers of excessive drinking are not deplored or even feared, but virtually all of our authors indicate that in most of the cultures with which they are dealing, the primary image is a positive one. Usually drinking is viewed as an important adjunct to sociability. Almost as often, it is seen as a relatively inexpensive and effective relaxant, or as an important accompaniment to food. The symbolic importance of drinking as a way of differentiating members of one population from another is closely linked with other emotionally laden symbolic meanings. Among these are a sense of identification with or participation in a more modern or cosmopolitan way of life, an indication of financial success and social status, or even of assertive masculinity. Its use in religions is ancient, and reflects social approval rather than scorn. Even some of the major religions that many outsiders believe to be abstemious do not enforce prohibition, and no secular state has succeeded in such experiments, although partial prohibition for various segments of the population based on age, sex, caste, or other criteria have sometimes been imposed. One generalization that emerges from these chapters is the somewhat surprising virtual unanimity with which the authors have cited a broad range of benefits of moderate drinking. This is gratifying, not because I have any vested interest in promoting drinking but because it replicates at the level of the nationstate many of the findings that I have reported in my crosscultural writing about tribal and peasant populations around the world. Some colleagues have questioned the reliability and validity of anthropological research methods, and others have wondered whether "modern" cultures may not be so wholly different from "primitive" ones that deep-seated customs and attitudes about drinking have become not only obsolete but also dangerous, and what is good for them may be bad for us. There are a few respects in which that may be true, but this -350does not appear to be one of them. It is in this connection that Room ( 1984) took ethnographers to task as "problem deflators"; however, few of those who commented on his article agreed with the charge. But the contributors to this volume are not ethnographers, nor are they of the age, professional training, or cultural background that Room ( 1984) suggested prompted too many anthropologists to ignore the dangers of drinking while emphasizing its joys among other peoples. Almost every one of the contributing authors has described positive functions of drinking in his or her country-benefits that accrue to the social fabric as well as to individuals--even when they have viewed with alarm certain risks, dangers, and harm that sometimes result from excessive drinking. This is a little surprising in light of the fact that most of our authors are professionally engaged in public health and social welfare activities that are aimed at preventing, treating, or otherwise ameliorating such damage. Most of them are not simply teachers or researchers who might be thought to enjoy the luxury of academic detachment; they are psychiatrists, physicians, and others who work daily in clinical settings, faced with the need for realistic decisions that affect the lives of the people they serve. These authors are not "problem deflators" who seek to put a happy face on native people, or to find theoretically satisfying functional interpretations for disruptive customs. This explanatory aside may appear to verge on overkill, but emotions run high on this subject, so I feel it is necessary to reassure readers who may be concerned that contributors were chosen, or their works cunningly edited, to show drinking in an unrealistically good light. Such is simply not the case.

For that matter, such a finding about the good aspects of drinking should not be surprising. In the United States, which has been labeled a prototypically "temperance culture" ( Room 1992; Levine 1992), national surveys--the same ones that tell us about drinking patterns and rates of problems--have repeatedly demonstrated that most of the serious drinking problems (of all kinds) occur in only about 10% of the drinkers (that is, less than 7% of the adult population), meaning that 90% of those who drink do so without such problems. Put another way, most people in the United States, Canada, and Sweden, when asked what emotions they associate with drinking, responded favorably, emphasizing personal satisfactions of relaxation, social values of sociability, an antidote to fatigue, and other positive features, with little mention of violence, illness, or other harm ( Pernanen 1991). Without for a moment wishing to diminish the human suffering that is unquestionably associated with certain kinds of drinking by a minority of those who drink, it is worthwhile in this context to summarize what an international sampling tells us about the benefits of moderate drinking, a theme that has been eclipsed in recent years by the mass and shrillness of writing about the harm that is done by excessive drinking. In fact, the same author who deplored "problem deflation" on the part of ethnographers ( Room 1984) wrote a few years later: "We are definitely in a period of [problem] amplification when there are strong tendencies to overstate alcohol's role in health and social -351problems, to forget that its causation is usually conditional, and to overlook solutions to the problems that are not alcohol specific" ( Room 1990b, 1357). Sociability and Hospitality

Drinking is fundamentally a social activity, and sociability is unquestionably the reason for drinking that is most cited in all of the countries that are described here. The same is true in almost all of the populations that have been studied by anthropologists around the world ( Heath 1975; Marshall 1979). Why this symbolism is so widespread is a complex question that involves an interplay of psychological and social variables, but the association is firmly established in most cultures ( Douglas 1987). We are told that alcohol is "indispensable" for sociability ( China, Denmark, Egypt). It is an integral part of "mateship" (male bonding) in Australia, Canada, and New Zealand; and "the regulars" are known and appreciated in pubs in Germany, Italy, and New Zealand. Drinking is "important to community solidarity" in Guatemala and among many of the tribal populations in India; it is said to be integral in relating to friends and general social participation in Spain and Mexico. Drinking games are a special expression of this in China, Germany, and Poland; drinking contests are common among men in France, Germany, and the UK. Almost every author speaks of an offer of alcohol as an important gesture of hospitality, even in countries that have relatively low overall consumption figures. Related to this is the recognition of drinking as a celebratory act, as is dramatically emphasized in the frequently elaborate secular ritual of toasting, which can go far to confirm one's acceptance within an alien group. Relaxation and Recreation

Alcohol seems often to be used, in small amounts, for just those purposes to which it is pharmacologically best suited, as a nontoxic relaxant that is readily metabolized. As such, it reduces fatigue. This is explicitly recognized by most of our authors, with special emphasis on the symbolic importance of drinking to mark the transition from workplace to leisure (in

India, Malaysia, Zambia; see Gusfield 1987). It is a frequent adjunct to festivals ( China, Guatemala, Mexico), and is sometimes mentioned as providing refreshing diversion when there are few other opportunities ( Iceland, Nigeria). Specific recreational activities that focus on alcohol include drinking games ( China, Germany) and drinking contests ( France, China). Because socializing is often so integral a part of relaxation and recreation, it should also be considered in this connection. Food and Its Enhancement

We have already mentioned that some alcoholic beverages are thought of and treated as foods in themselves, and a few are judged by nutritionists as fully -352deserving that label. Others are viewed as having a gustatory or aesthetic quality that makes them valuable adjuncts to food because they stimulate the appetite, enhance flavor, aid digestion, and so forth. Wine is often an important part of a meal ( France, Italy, Spain), and an elaborate sequence has evolved combining alcohol and food throughout the entire day (in Spain). This can involve elaborate ritualization, with a specialized vocabulary and matériel (as among wine connoisseurs), but it can also be simple and straightforward as an integral part of workaday eating. It is specifically noted that this is not a pattern in India, and it may also be absent in most of the settings where drinking takes place primarily in episodic binges, but it appears otherwise to be extremely widespread. Status and Health

To a remarkable degree, people seem to focus on what or how a person drinks--even more than on what or how one eats--as a marker of social status. This is reflected in the frequency with which our authors mention drinking as a symbol of manliness or valor ( Chile, Denmark, France, Germany, Honduras, Mexico, Malaysia), and on people's changing their drinking habits as they achieve or aspire to upward social mobility ( India, Sri Lanka, Zambia). In a more role-specific way, the effectiveness of a shaman in tribal India can be enhanced by the use of alcohol to alter consciousness. As a symbolic adjunct to ceremonies that confirm the assignment of specific titles in Nigeria, alcohol confers a special power on traditional ritual activities. Drinking patterns are often described as important boundary markers between ethnic groups, just as the choice to drink or to abstain is often a symbolic marker of importance to different religions, endowed with considerable affect and emotion. Alcohol has long been viewed as a drug in the beneficial sense of helping to prevent or to cure a wide range of physical maladies, whether we speak of disease (in the sense in which scientists diagnose and treat symptoms) or of illness (the subjective dis-ease that a patient experiences). Chinese and Russian physicians still recognize a number of specific problems for which alcohol serves as a medicine, and there is the widespread belief in many wine cultures that "wine strengthens the blood," is beneficial to a nursing mother, or helps people to stave off the cold. Considerable scientific research has focused on "the French paradox" ( Ford 1993; Perdue 1992), in which the French enjoy a relatively low rate of coronary heart disease (the leading cause of death for significant portions of the population in the United States and elsewhere) even though they eat far more saturated fats, exercise less, smoke more, and drink more. This is one of those instances where systematic research is confirming long-held popular beliefs, and wine turns out to be positively healthful in many respects. For

that matter, it is not only red wine (as some originally thought) but any form of ethanol that has all of these benefits: "alcohol lowers harmful LDL-cholesterol levels; raises protective HDL-cholesterol levels; decreases formation of blood -353clots in the arteries; increases coronary blood flow; [and] increases estrogen levels" ( Ellison 1993, 3). Fully cognizant that any discussion of the benefits of moderate drinking is likely to be highly controversial, I owe it to my readers to provide some caveats. The notion of "moderate drinking" is by no means a culture-free one, since any drinking at all may be seen as excessive by a devout Muslim or fundamentalist Protestant, or by a recovering alcoholic who fears that "failing off the wagon" could jeopardize his or her sobriety and do irreparable damage to physical health, mental stability, and social relations. Individuals vary enormously in their tolerance for alcohol (that is, how much reaction from a given dose)-just as they do in their tolerance for fava beans, sugar, salt, strawberries, lactase, or other substances. It is also clear that there are certain situations in which drinking can be inherently risky (such as prior to operating heavy equipment, or whenever immediate and substantial coordinated responses are requisite). Otherwise, for most people, alcohol can serve all of the foregoing functions at levels that do no damage to the body, that are quickly metabolized, and that do not seriously impede the performance of normal daily activities. Following Ellison ( 1993), from whom these important data about recent scientific advances in medicine are summarized, I am using two drinks a day as a cautious and convenient measure for "moderate drinking." Large-scale epidemiological research on various ethnic populations in many different parts of the world shows that people who have one or two drinks a day live longer than those who drink more-and also longer than those who drink less. The J-shaped curve is remarkably consistent, showing that healthy abstainers (not confusing them with sickly former drinkers who abstain after damage has already been done) have more deaths from virtually all other causes than do "moderate drinkers," with rates rising rapidly as consumption increases beyond the "moderate" level. In all fairness, mention should be made of what is perceived by many to be a benefit of immoderate (or heavy) drinking. A simple measure of "heavy drinking" that relates more to the potential for physical damage than to local culture or customs, would be about six drinks a day. Incidentally, the acute impact of alcohol on the system is such that even a moderate drinker's one or two drinks a day would not be innocuous if they were "saved up" to allow a seven to fourteen-drink binge on the weekend. With reference to heavy drinking, it must be admitted that drunkenness is often considered to be a positive value in its own right, quite apart from the act of drinking and whatever benefits may accrue from it. Drinking that might result in drunkenness (for most people, at least five drinks within an hour) could usually be considered "excessive"--except that the aesthetics of behavior differ markedly, as we have seen, and such heavier or faster drinking is not thought to be excessive by those who esteem and actively seek intoxication. In Chile, China, Denmark, Germany, and Mexico, it is mentioned specifically as an affirmation of masculinity; many tribal and peasant cultures make the same association. Guatemalan and Honduran Indians cherish it as a form of trans-

-354cendence in connection with various rituals; this is also common in the ethnographic literature, and William James ( 1912) even spoke of it as important among the Western "varieties of religious experience." In Iceland, it is said to provide "release," and in France it is embraced as combining ecstasy with rapture. In Italy, where the traditional wine culture encourages considerable drinking, there are only a few festive occasions when "regulated abuse" is tolerated; drunkenness is considered foolish in other contexts. Some adolescents in India appear to have embraced drunkenness as a form of rebellion, just as impoverished Sri Lankans may have mistakenly adopted it as symbolizing fun and freedom that the wealthy enjoy. Comparative studies clearly show that the effects of drunkenness are more cultural than they are pharmacological ( MacAndrew and Edgerton 1969). This means that the drowsiness, clowning, violence, crime, sexual or verbal aggression, maudlin sentimentality, loquacity, spousal or child abuse, or other concomitants of drunkenness are shaped far more by expectations than by the interaction of alcohol with human physiology. Although drunkenness with such beneficial effects as those described above cannot properly be called the result of moderate drinking, it is not clear whether the heavy drinking that causes it should be called "excessive," inasmuch as the benefits appear to outweigh the costs in the judgment of those who matter most: the people whose lives are immediately affected by it. RISKS OF HEAVY DRINKING

It is clear that "heavy drinking" is no more a culture-free term than is "moderate drinking"; but in the interests of combining caution with convenience, I follow Ellison ( 1993) in using six drinks a day as an arbitrary measure (which is low in international perspective, as attested by the contributing authors). Although there are some contexts in which drunkenness is valued and actively sought (as described above), such drinking is not regularly accompanied by the positive benefits--for the individual as well as for society--that come with moderate drinking, and there are unquestionable risks. Epidemiological researchers are not consistent in the quality of data they collect, nor do they always use the same numerical scales for counting quantity and frequency of alcohol consumption. However, there does appear always to be a rapid rise in the rate of damage (whether from coronary heart disease or other problems with health) as daily consumption exceeds six drinks. The authors in this book are not all specialists whose research focuses on the epidemiological coincidence of drinking and various problems, but they are all familiar with that literature, and most of them offer at least a few important generalizations with respect to the situation of their countries. Liver cirrhosis, which used to be considered a good measure of alcoholism, proved to be caused by so many other factors that it lost its role as a direct index for all other drinking problems. Nevertheless, it is still important enough -355to have been mentioned in relation to Australia, France, and Italy. Traffic accidents, whether correctly linked with alcohol or not, are mentioned in Australia, Iceland, India, Israel, Mexico, and New Zealand. A few specific cancers tend to be associated with drinking (in

Australia and Mexico), and alcohol poisoning sometimes occurs when too much alcohol is administered as a medicine to young children in Nigeria. Mental disorders and psychological problems are sometimes said to be caused by excessive drinking ( Israel, Poland, Russia). Australian Aborigines, Mapuche Indians in Chile, and some Hondurans and Sri Lankans fear violence from heavy drinkers, but such behavior is invariably directed along lines that reflect stresses in the local culture rather than being random. In Guatemala, Mexico, New Zealand, and Russia, drunken violence is sometimes expressed within the family; in the UK, it tends to be public hooliganism associated with gangs of sports fans. The French fear losing selfcontrol if one drinks too much, although they cherish the sensuality and esthetics of ivresse (being "high"), whereas Guatemalans and Malaysians are more concerned about the economic costs to the individual or to the household. In Italy, it is believed that drinking too much makes a woman sexually vulnerable, and in Iceland, divorce is cited (without further explanation) as a common outcome of drunkenness, which is frequent there despite overall low consumption of alcohol. There is no doubt that most people are aware of certain risks associated with heavy drinking, but the specific nature of those risks differs considerably from one country to another, as it does in various cultures. There is remarkably little consensus about the nature of "alcoholrelated problems" or, for that matter, whether the major problems are those suffered by the drinker, by others who are close to the drinker, or by the community at large. An abundant and insightful corpus of literature deals with the sociologically significant point that what constitutes a "problem" is socially defined ( Gusfield 1981; Wiener 1981). An important warning to emerge from these data should be recognition that many of the associations that are so glibly presumed by the media are far from being commonplace, such as the supposed link between alcohol and violence, sexual forwardness, indecent language, sacrilege, and so on. It may be that many of the authors would have listed more of the risks of heavy drinking and put more emphasis on them--as some of them have done in other contexts--if they had not been viewing alcohol at least partially through the lens of cultural analysis. A basic conceptual question must be faced: Why would a trait such as alcohol use have survived and flourished if it were so maladaptive as most critics make it out to be? Perhaps a major part of the answer lies in the fact that alcohol use for most people means moderate drinking, in ways that tend to be beneficial for both the individual and the social group. Frequent heavy or excessive drinking is an aberration in most societies, just as abstention is. Since both abstention and excessive drinking are extreme rather than normal behaviors in most cultures, there is a limited need for controls to -356lessen harm to individuals and to the group, which brings us squarely to the realm of policy. ALCOHOL POLICIES

Countries and social groups, like persons, seek to protect themselves from harm. That often requires that they encourage certain forms of behavior and discourage others. Alcohol was subject to strict control even in the earliest corpus of written law that we know; the Code of Hammurabi in Babylon, around 2000 B.C., contains more on alcohol, including a number of consumer-protection measures, than on any other subject. Since the 1890s, drinking has been subject to increasingly strict regulation, even in areas where it had been little controlled

earlier. Furthermore, the growth of international bodies that conduct research, and of others that are concerned with public health and social welfare, has resulted in the promulgation of recommendations on a cross-cultural scale that had never been contemplated earlier. Within the United Nations, the World Health Organization early paid attention to alcohol as a widely used psychoactive (or mood-altering) substance with the potential to impact health on a grand scale. From the beginnings, there were efforts to recognize national and cultural differences, without ignoring or homogenizing them, and interesting efforts have been made at doing collaborative research in different countries that would allow direct comparability ( Rootman and Moser 1984). The results were not so promising as had been hoped, but authorities in many areas welcomed the interest, support, and expressions of concern from such a prestigious international agency. Although there are many who still believe that drinking should be of interest to no one other than the drinker, social scientists discovered a conceptual "handle" for promoting international intervention in a finding that stemmed from a study in the Scandinavian countries: "changes in the overall consumption of alcoholic beverages have a bearing on the health of the people in any society. Alcohol control measures can be used to limit consumption; thus, control of alcohol availability becomes a public health issue" ( Bruun et al. 1975, 90). From that innocuous statement, hedged about with scientific caution, there rapidly evolved a succession of pronouncements that became progressively more strident, converting what bad been a mere inference into a virtual axiom. The rapid progressive exploitation of this apparent scientific justification for political action was neatly documented in a paper by Room ( 1992) that traced a succession of quotations, each more assertive than the last. Perhaps the culmination was the assertion by the director general of WHO that "any reduction in per capita consumption will be attended by a significant decrease in alcohol related problems" ( World Health Organization 1978, 4). Since then, although the exact nature of the "bearing" in the original cautious suggestion from Bruun et al. ( 1975) was never clear, it has been treated like an invariant scientific law linked with a moral imperative. It has become common for writers to assume -357(without any references or documentation) that it is common knowledge, or "everyone knows," that problems vary with consumption, and for that reason, consumption should be decreased. Such was the gist of World Health Assembly Resolution 32.40 (World Health Assembly 1979), which urged "all Member States to take all appropriate measures to reduce consumption among all sectors of the population." A number of national policies concerning alcohol were analyzed (all in Europe and North America) and a bundle of restrictions on availability ( Mäkelä et al. 1981; Single et al. 1981; Davies and Walsh 1985; Grant 1985) similar to those listed in the chapter on Nigeria were recommended. Significant increases in taxes on alcohol are supposed to discourage drinking, and to provide additional funds for prevention and treatment of problems. Stricter regulation of licensing, fewer hours of sale, and a higher minimum purchase age are supposed to make alcohol harder to get, especially for youth. The indexing of prices should assure that drinking does not become cheaper with monetary inflation. Restrictions (or, in some places a full ban) on advertising supposedly diminish popular interest, and warning labels on containers are meant to educate and discourage drinkers.

There is conflicting evidence about whether any of these measures would significantly curtail consumption, just as there is conflicting evidence about whether curtailing consumption would, in fact, diminish problems. But we must remember that these are political rather than scientific recommendations. Several of the chapters in this book show that problems do not occur in proportion to consumption; and, for that matter, so do many of the articles written by proponents of the additional controls on availability (e.g., in Single et al. 1981; Mäkelä et al., 1981; Grant 1985). Several critics have suggested that the control model is targeted at moderate drinkers who would be inconvenienced more than it is at heavy drinkers, who would continue drinking at whatever cost. An alternative sociocultural model has been proposed ( Heath 1992) that would not interfere with those moderate drinkers who wish to continue, for whatever social or personal benefit, but that would aim gradually to diminish problems by curtailing excessive drinking. It is striking that social attitudes have changed so rapidly with respect to alcohol in recent years. The infamous "threemartini business lunch" is history; newspapers and courts now take seriously DWI, which used to be treated as a joke unless someone was killed. Comedians find that most audiences do not appreciate jokes about drunks; and cocktail parties have become rare in many circles. Such sensitization or consciousnessraising is often not recognized as a product of education; the changing of cultural norms often takes place outside of the classroom. Much remains to be done in the way of broadening popular acceptance of the premises that heavy drinking is risky and that some forms of behavior are inexcusable, whether one is drunk or not. Addressing attitudes and values is probably the most effective way, in the long run, to change patterns of belief and behavior, because even the strictest -358nation-state is hard put to enforce its laws and regulations when they conflict with the culture of the people. The human experience abounds with evidence, both cross-cultural and international, that people can use alcohol in a variety of responsible and fruitful ways. In recent years, a small minority of those who drink, many of whom also take a range of illegal drugs for various reasons, have acted in asocial and antisocial ways that harm themselves and others. Correcting and avoiding such misbehavior can probably be done more effectively by a combination of education (in the broad sense) and peer pressure than by the police, courts, or other remote authority. With such a sociocultural approach to alcohol, combined with letting people know honestly what it is and what it can do, many of the socalled alcohol-related problems would continue to lessen, probably at an accelerating rate. Those who want nothing to do with alcohol should be allowed to leave it alone. But those who want to drink moderately, for whatever among its benefits suits them at any time, should be confident that their behavior is neither deviant nor drug-addicted, but fits well in the vivid panorama of human history. REFERENCES

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1975. Alcohol Control Policies in Public Health Perspective. Helsinki: Finnish Foundation for Alcohol Studies. Davies, Phil, and Dermot Walsh. 1985. Alcohol Problems and Alcohol Control in Europe. London: Croom Helm. Douglas Mary (Ed.). 1987. Constructive Drinking: Perspectives on Drink from Anthropology. Cambridge: Cambridge University Press. Ellison R. Curtis. 1993. Does Moderate Alcohol Consumption Prolong Life? 2nd ed. New York: American Council on Science and Health. Ford Gene. 1993. The French Paradox and Drinking for Health. San Francisco: Wine Appreciation Guild. Grant Marcus (Ed.). 1985. Alcohol Policies. Copenhagen: World Health Organization, Regional Office for Europe. Gusfield Joseph R. 1981. The Culture of Public Problems: Drinking-Driving and the Symbolic Order. Chicago: University of Chicago Press. -----. 1987. Passage to play: Rituals of drinking time in American society. Pp. 73-90 in Mary Douglas (Ed.). Constructive Drinking: Perspectives on Drink from Anthropology. Cambridge: Cambridge University Press. Heath Dwight B. 1975. A critical review of ethnographic studies of alcohol use. Pp. 192 in R. Gibbins. Y. Israel, H. Kalant, R. Popham, W. Schmidt, and R. Smart (Eds.). Research Advances in Alcohol and Drug Problems. Vol. 2. New York: John Wiley and Sons. -----. 1989. "The New Temperance Movement: Through the looking glass". Drugs and Society 3( 3/ 4):143-168. -359-